Is chronic heel pain preventing you from enjoying life to the fullest? Are you in pain when you first get up in the morning, or by the end of the day?
Let me tell you about the most common cause of heel pain and give you
5 tips to settle heel pain
Pain felt under the heel (and at times under the arch of the foot) is most commonly plantar fasciitis (more correctly called plantar fasciopathy).
Plantar fasciitis is the most common painful foot complaint, usually lasting longer than 6 months without treatment, and occurring in 10-15% of the population. Plantar heel pain is the most common foot condition treated in physiotherapy clinics.
So what is the Plantar Fascia?
The plantar fascia is a strong band of tissue extending from the base of the toes to the heel bone. It supports the arch of the foot especially as we walk or run – it acts as a shock absorbing system.
If it is overstressed repeatedly, micro trauma occurs at or near its attachment to the heel. Ongoing overuse or stress prevents normal healing, leading to long term symptoms.
What are the usual symptoms of Plantar Fasciitis?
- Heel pain on your first steps in the morning, or after prolonged sitting.
- Tenderness under the heel and perhaps along the plantar fascia
- A limp, especially in the morning on first arising, or towards the end of the day as the heel pain increases again.
- Pain is usually worse walking barefoot on hard surfaces, or when wearing particular shoes.
What contributes to getting Plantar Fasciitis?
The main cause of heel pain is the overstretching of the plantar fascia, and this can be caused by:
· Abnormal foot biomechanics (eg flat feet or feet that roll inwards).
· Being on your feet all day at work (“Policeman’s Foot”).
· Running sports.
· Weight gain – increases the stress on all weight bearing structures eg the plantar fascia
· Stiff ankles & feet, and tight calf muscles.
· Poor footwear that offers no support, or going barefoot on hard surfaces.
· Diabetes.
What can you do yourself to ease your heel pain?
5 tips to settle heel pain
These 5 tips can give you substantial relief before you turn to your physio for help (see below).
1. Relative rest/reduced activity
If you reduce the stress on the structures that are affected, the body may be able to heal itself. In the first 4 weeks avoid running sports, walking any distance, and walking up & down hills. Also don’t walk barefoot on hard surfaces!
If you reduce the stress on the structures that are affected, the body may be able to heal itself. In the first 4 weeks avoid running sports, walking any distance, and walking up & down hills. Also don’t walk barefoot on hard surfaces!
2. Ice (or heat)
You will find that applying ice packs to the heel 2-3 times daily for 15 minutes will give considerable relief – especially at the end of the day. Occasionally heel pain sufferers prefer local heat applied to the arch and heel.
You will find that applying ice packs to the heel 2-3 times daily for 15 minutes will give considerable relief – especially at the end of the day. Occasionally heel pain sufferers prefer local heat applied to the arch and heel.
3. Gentle stretch exercises
Gently stretching the plantar fascia (rest you foot on the other knee and pull your toes back with your hand) and the calf muscles (lean against the wall with the leg out behind you) will help stretch out tightness, and can often give immediate relief, especially in the morning and at the end of the day.
Gently stretching the plantar fascia (rest you foot on the other knee and pull your toes back with your hand) and the calf muscles (lean against the wall with the leg out behind you) will help stretch out tightness, and can often give immediate relief, especially in the morning and at the end of the day.
4. Massage
Massaging along the full length of your plantar fascia will not only give some pain relief, but help lengthen the tight plantar fascia. Even better – get someone else to massage your foot while you relax! You can also use a special roller or plastic bottle on the floor to roll back and forth along the plantar fascia.
Massaging along the full length of your plantar fascia will not only give some pain relief, but help lengthen the tight plantar fascia. Even better – get someone else to massage your foot while you relax! You can also use a special roller or plastic bottle on the floor to roll back and forth along the plantar fascia.
5. Support Socks
Specially designed tight support socks (eg Orthosleeve TS6) support and compress the arch and heel during the day, often giving considerable relief.
Specially designed tight support socks (eg Orthosleeve TS6) support and compress the arch and heel during the day, often giving considerable relief.
If these simple remedies do not settle your heel pain within 2 weeks, then you need to seek help from a physiotherapist with a special interest in heel pain.
How does a Physiotherapist treat plantar fasciitis?
After a careful assessment to confirm the diagnosis of plantar fasciitis, the physio can offer:
· Orthotics
If you have any abnormal foot biomechanics, and the most common are pronated feet (feet that roll inwards giving the appearance of flat feet), then the first step to a cure of your plantar fasciitis is correcting this with orthotics – inserts in your shoes. The physio uses “off the shelf” orthotics which are then customised to your feet. This is a very economical but effective way to correct the abnormal biomechanics of your feet.
If you have any abnormal foot biomechanics, and the most common are pronated feet (feet that roll inwards giving the appearance of flat feet), then the first step to a cure of your plantar fasciitis is correcting this with orthotics – inserts in your shoes. The physio uses “off the shelf” orthotics which are then customised to your feet. This is a very economical but effective way to correct the abnormal biomechanics of your feet.
· ExercisesA vital part of the rehabilitation of plantar fasciitis is exercise – both to stretch and strengthen. Your physiotherapist will provide instruction in the correct exercises for you, and then progress them as you improve.
· Mobilisation
If the physiotherapist finds stiffness in your ankles or feet, mobilisation techniques allied to exercises will be used to restore full mobility. This can alleviate the stress on the plantar fascia.
If the physiotherapist finds stiffness in your ankles or feet, mobilisation techniques allied to exercises will be used to restore full mobility. This can alleviate the stress on the plantar fascia.
· Muscle release
It is common to find tightness in both the foot and calf musculature, so your physiotherapist will work to release this tightness. Your stretching exercises will reinforce the physio’s treatment.
It is common to find tightness in both the foot and calf musculature, so your physiotherapist will work to release this tightness. Your stretching exercises will reinforce the physio’s treatment.
· SHOCKWAVE THERAPY (SWT):
What is Shockwave Therapy?
SWT is a modern noninvasive treatment that uses acoustic pressure waves to deliver a mechanical stimulus to the body’s tissues. There is strong clinical research evidence that shows that when allied to specific exercises, 80 to 90% of patients can be helped.
SWT is a modern noninvasive treatment that uses acoustic pressure waves to deliver a mechanical stimulus to the body’s tissues. There is strong clinical research evidence that shows that when allied to specific exercises, 80 to 90% of patients can be helped.
How does it help plantar fasciitis?
SWT accelerates the healing process by activating the body’s self- healing capabilities through:
Ø New blood vessel formation
Ø Reversal of chronic inflammation
Ø Stimulate fibroblast cells to resume the healing process
Ø Disperse pain mediators
Ø Release trigger points in muscles
Shockwave therapy advantages:
Ø Noninvasive treatment.
Ø Relatively pain-free.
Ø No “downtime” after each treatment.
Ø Stimulates the body’s normal healing processes.
Ø Safe, quick and effective treatment.
Bruce Paulik
Musculoskeletal Physiotherapist
ISMST Internationally Certified Shockwave
Therapy practitioner
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