Heel Pain – How do you treat it?
What is Plantar Fascitis?
Plantar heel pain, commonly referred to as Plantar Fascitis or Plantar Fasciopathy. A condition of pain and tissue damage at the attachment of the plantar fascia to the underside of the calcaneus (heel bone).
The plantar fascia is a band of connective tissue, it runs along the sole of the foot from the heel to the ball of the foot. One of its main roles is to keep the bones and joints in position. It enables us to push off and propel forward from the ground. Bruising or overstretching this ligament can cause inflammation, degeneration and heel pain. In many cases, plantar fascitis is associated with a heel spur. Surprisingly, the spur itself does not cause pain as a result may often be found in the other foot without symptoms.
Signs and Symptoms
Pain is usually felt on the underside of the heel. It is often most intense with the first steps of the day or after rest. Commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity.
Risk Factors to developing Heel Pain:
- Certain sports – Like running place a lot of stress on the Plantar Fascia
- Being on feet a lot – Walking or standing on hard surfaces for prolonged periods of time places strain on the tissue
- Wearing inappropriate or poorly designed footwear – Can be a strong contributing factor to the pain
- Flat Footed or High Arches – People with a specific foot type can be predisposed to increased stress/load in the Plantar Fascia
- Overweight individuals – At a higher risk of developing Heel Pain, weight places a greater me-chanical load on the Plantar Fascia leading to tissue damage and subsequent pain
- Pregnancy, hormonal changes – Accompanied with weight gain can lead to a mechanical overload of the plantar fascia
- Age – Heel pain is generally more common with ageing, for the reason that muscles supporting the foot can become weaker placing more stress on the Plantar Fascia
Tips to Prevent developing Heel Pain:
- Maintain a health weight to avoid overloading the Tissue
- Choose suitable footwear with adequate support and cushioning
- Don’t wear worn out runners and replace running shoes every 500-600 kms
- When starting a new activity or sport, first of all start out slowly managing training load. Allow adequate time for tissues to adapt to the increased load they are under, similarly doing too much too soon creates strain.
- Strength and Flexibility, engage in some strength and conditioning exercise specific to your sport
- Quality Sleep and Nutrition, sleep is very important for recovery, growth and repair, and fuelling the body with the right types of foods plays an important role in injury prevention
Treatment and Management
How can a Podiatrist help to treat Heel Pain?
1) Reduce the load in the damaged tissues
Plantar Fasciitis/Fasciopathy is caused by excessive mechanical load in the tissue, reducing the load in the short term facilitates healing. There are a few useful strategies for this;
• Foot Orthoses – Orthoses with the appropriate design features are effective in reducing the load in the Plantar Fascia
• Low Dye Strapping – Effective method of strapping can reduce the load in the tissue immediately leading to immediate pain relief
• Reduce training load – Stopping or modifying running or other activities until the tissues heal and pain subsides
• Calf muscle and Plantar Fascia stretching – stretching the calf muscles has been shown to be effective in reducing the load in the Plantar Fascia
2) Increase the ability of the Tissues to take the Load
• High Load Strength Training for Plantar Fascitis – Aimed at progressively and slowly increasing the load in the Plantar Fascia so that it can adapt to better tolerate the loads that are placed on it. Evidence suggests High Load Strength training may aid in quicker reduction in pain and improvements in function
• Nutrition – Needs to be considered for optimum tissue health
3) Facilitate the Healing of the Tissues
• Reducing the load in the tissue and increasing the tissues ability to take the load are extremely important. If not done the problem is more likely to become long term and chronic, therefore more likely to reoccur. Direct work on injured tissue may be necessary to facilitate healing.
• Examples of treatment in this category include – Icing, Manual Therapy, Dry Needling, Shock-wave therapy, NSAIDS, Cortisone Injections, Platelet Rich Plasma Injections
There is no need for Heel Pain to become a long term chronic problem. Early appropriate intervention ensures the best outcome with a quicker reduction in pain, improved function longer term and reduced likelihood of re-occurrence.
Start by reducing load in the injured structure, also do things to facilitate the healing then progress to progressive adaptation to increasing loads. Simple!
Come and see Jarlath O’Neill, Podiatrist