What causes heel pain?
Heel pain, or as it is officially known Chronic Plantar heel pain (CPHP) is usually a change in the nature of the tissue within the sole of your foot, attaching to your heel bone called the Plantarfascia – hence the official name plantar fasciitis. This structure acts as a strong guidewire between the heel and the big toe as you move through your foot as part of walking and running.
More rarely, CPHP can affect the heel bone itself, and sometimes the heel pad. In children the condition must be differentiated from growth plate pain in the region (Sever’s disease), and in adults medical conditions such as gout.
There are really four things which make CPHP more likely (risk factors). Firstly, bodyweight. If you are heavier than your would like, you are at a greater risk of developing the condition, and if you do get it recovery takes longer. Secondly, how much time you spend standing. Heel pain is more commonly seen in occupations where people stand for long periods such as shop workers, uniform services, or teachers for example. When treating the condition, reducing the amount of standing is often a key element. Thirdly, if you have a lower foot arch (see below) you are more at risk of the conditions, and if you have heel pain, getting an arch support (at least temporarily) can give you some relief. Finally, if you calf and achilles are tight, the mechanics of the foot and its arch change slightly, placing more stress on the foot tissues which may lead to CPHP. This is why calf stretching is often used as part of a treatment package.
Risk factors for Plantar fasciitis
What does it feel like
You notice a dull ache in front and slightly to the inside of your heel, as This is normally worse in the morning and at first the pain gradually reduces after you have taken a few steps. As the condition worsens prolonged standing and walking in general becomes painful. Often you notice that more supportive shoes help, and sometimes the height of the shoe heal affects the condition.
often it feels like you are stepping on a small stone or marble.
What your physio can do
Physios at Norris Health will aim to help the reactive tissue recover initially before introducing a progressive rehabilitation program. The tissue reacts in the way it does giving pain because it has been overloaded. You may have put on weight, increased your activities, or simply spent a long time standing. This causes the tissue to react and if rested if will slowly recover. However, early on it is often not convenient to rest and so the tissue reaction continues and the condition develops
Tissue recovery – Initially your physio will try to ease pain by allowing the tissue to recover. They may use a special taping (low dye tape) or a shoe insert (temporary orthotic), together with hands on techniques to ease pain. They will often show you things you can do at home to help with pain and talk to you about footwear, and planning your day to take strain off your foot.
Beginning a plantarfascia taping
Tissue loading – As the condition begins to resolve and pain lessens, you will begin to load the tissue in the sole of your foot to strengthen it again. This is vital because scientific studies have shown that without this the condition can take longer to heel and is liable to recur. The tissue is loaded using special exercises which you will do at home. This will cause a little pain (a bit like the aching you get after you have done a good workout in the gym) which is a sign that the right tissues are being targeted. Importantly your physio will explain how to identify the right and wrong amount of pain – one helps, and the other can make things worse!
In persistent cases your physiotherapist may offer shockwave therapy (ESWT). This is often used as an alternative to steroid injections and has been shown to help cases of plantar heel pain. See our separate blog on Shockwave therapy CLICK HERE
What you can do
Heel raise actions in bare feet can help to load the plantarfascia to help recovery. Stand with your hands on a wall in barefeet and slowly flex your foot to lift up onto your toes. As you do this try to keep your heel bones in line, trying not to allow your heelbones to flare outwards, and avoiding a flat foot position as you come back down. Perform about 5-8 repetitions so you feel a little discomfort in the sole of your foot, but not a lot. Rest, and then repeat this action building up to 3 sets of 5-8 reps. Do this each day and build up to twice a day as you are able to do more without making the pain worse.
Plantarfascia loading exercise
Self massage can also help to reduce pain. Cross your painful side leg over the good leg and flex your foot and big toe joint. This position causes the plantafascia to stand out, allowing you to gently press into it. Press and hold for about 3-5 secs and then move onto another painful region. Aim to cover a 10cms band from your heel towards your toes.
Planar self massage
Bottom line
Most often this condition can be treated without injections or surgery. The key is guided physiotherapy to help strengthen the foot gradually. This may take a long time (up to three months) but remember you will be doing most of the exercises at home. It is worth persevering with the home exercise program to build a strong foot and help prevent the condition coming back.
It is worth persevering with the home exercise program to build a strong foot and help prevent the condition coming back.
Want to know more? Reach Dr Chris Norris’ article in Co-Kinetic sports journal CLICK HERE
