heel pain and plantar fasciitis
Heel pain affects up to 10% of the population. Although it has been known to solve itself, it can also become debilitating and activity limiting and is notoriously difficult to treat. Your first step to improvement is good self-care. This information will tell you more about the condition, how best to manage it yourself and what to do if the first-line treatments don’t work.
the plantar fascia
The plantar fascia is s a tight band of tissue that helps to support the arch of the foot and provides shock-absorption. It also protects the nerves, muscles, blood vessels and tendons under it. Plantar Fasciitis is a syndrome which affects the plantar fascia at the point it anchors onto the heel bone.
causes of plantar fasciitis
Tight calf muscles which increase the tension in the plantar fascia when you walk or run and affect the position of your foot.
Standing for long periods of time causing compression of the plantar fascia where it inserts into the bone and also increasing tension along the plantar fascia
Weight gain which puts extra strain through the plantar fascia and can lead to trauma with each step.
Poor footwear that provides little or no support can lead to heel pain, as can inappropriate shoes for the activity being performed. Long walks in flip-flops being an example.
Changes in activity A sudden increase in duration or intensity of exercise can cause the tissues of the sole of the foot to become aggravated.
first line treatments
Ice will provide pain relief and reduction of any inflammation at the site of the pain. You can use as sports ice pack or a bag of frozen peas (wrapped in a tea towel). Use on the area for 10-15 minutes at least once a day. Gin is optional.
Massage along the arch with an arch-roller or bottle. These can be chilled before use too.
Ibuprofen gel, used as directed, may also improve the pain.
Footwear changes to a good supportive shoe with a cushioning sole can help. Often a shoe that is not completely flat will give better relief.
Gel heel raises are a good first line treatment to cushion the heel. They also raise the heel off the ground which reduces the tension through the plantar fascia.
Calf stretching exercises are essential in treatment and can be very effective. If your calf muscles are very tight you will need to increase these gradually.
1. Use a band around your feet, whilst sitting,to pull your toes towards you, holding for 15 seconds and repeat.
2. Stand facing a wall, one foot in front of the other, your feet hip distance apart and parallel. Lean forwards, resting your hands on the wall. By keeping the back leg straight and heel on the ground, you should feel a stretch in your calf muscle. Hold this stretch for 15 seconds and repeat several times on each leg.
3. Stand with your heels over the edge of a step. Rise up onto your tip-toes. Gradually allow your heels to come down, a little at a time, until your heels are below the level of your toes and you feel the stretch in your calves. Hole this stretch for 15 seconds. Repeat several times. You can progress by rising up on both feet but coming down on one leg only.
Where symptoms are not improved by first-line self-care, a Podiatrist is the next step. The Podiatrist will firstly take a history of your symptoms and then assess your standing and walking to find the cause of your heel pain. Whilst plantar fasciitis is the most common cause of heel pain, there are other causes that may respond better to different treatment. These include; Tarsal Tunnel Syndrome, Fat Pad Atrophy, Tibialis Posterior Dysfunction, Baxter’s Nerve Entrapment and Calcaneal Fracture.
Many people with heel pain benefit from orthoses. They can improve the foot function and rest the plantar fascia sufficiently to provide relief. A shoe with good arch support or generic arch supports, purchased over the internet or from the chemist, generally do not provide enough support to give relief, or effectiveness is only short-lived. Orthotics are not just arch supports. The best way to get the correct device is to seek the advice of a Podiatrist for full assessment of your standing and walking position. Orthotics, if required, will be individually prescribed.
At the Podiatry assessment, you may also be given more exercises to perform at home as part of your rehabilitation plan.
More than 50% of heel pain will be significantly improved with the treatments above, however, there are more options for those more stubborn cases. Shockwave therapy has shown good results with minimal side effects. Steroid or local anaesthetic injections can also give good results, but there are side effects to consider. And lastly, surgery may be considered for the worst cases that do not respond to all other treatments.
"After suffering for nearly a year with awful heel pain, someone recommended The Foot Room. I was very impressed with the treatment I got. I have had orthotics in my shoes now for about 10 months and the pain was completely gone within the first week of wearing them. I'm still pain free now. I would highly recommend them"