Is heel pain making your life a daily struggle? Don’t put up with it any longer…
Heel pain can be debilitating and can affect the quality of life of the sufferer. After reading this blog, you should have a better understanding of how heel pain is caused, how to treat and manage it, and how to prevent it from happening again.
Heel pain has many causes, the most common two you may know of is Plantar Fasciitis (bottom of the heel also called plantar heel pain) and Achilles tendinitis (back of the heel pain), both of which can affect both athletes and non-athletes. I will be concentrating on plantar heel pain.
A term that better describes plantar heel pain, is Plantar Fasciopathy (PF). The term ‘fasciopathy’ better describes the changes that are mainly happening within the fascia, which is thickening and degeneration of the fascial tissue, compared to the less common inflammatory changes which plantar fasciitis refers to.
Sufferers will describe the pain as a sharp excruciating pain on the inside of the heel on first walking in the morning when getting out of bed – ‘first step pain;’ and after a period of rest- from sitting to rising. The pain eases after walking a little while.
The pain experienced can worsen by the end of your working day, after long periods of walking and standing, or after impact sporting activities.
What is the Plantar Fascia and what is its purpose?
The fascia is a band of tissue connecting the front of the foot and the heel, forming the arch, supporting the foot, and absorbing shock going through the foot as you stand, walk, or run.
How is plantar heel pain caused?
Plantar fasciopathy can be caused by:
- a sudden increase in the amount of activity you do
- being on your feet for too long
- exercising on hard surfaces
- weight gain, as it increases the strain on your feet
- certain foot types, high or low arched feet
- ageing, as it is more common in people over 40
- shoes that do not cushion or support the soles of your feet
- tightness in the calf muscle
These are the facts on PF:
- It is very prevalent, affecting 1 in 10 people in their lifetime between the ages of 45 and 65
- It affects men and women equally
- Around 90% of cases will resolve within 12 months with conservative treatment
- Tightness in the calf muscle has been associated with stiffness in the ankle joint and damage to the plantar fascia.
What are the risk factors of PF?
Age related – physiological changes in the fascia can lead to stiffening and inelasticity in the fascia, making it a poor shock absorber, thereby rendering it more susceptible to trauma.
Body weight – individuals with a high body mass BMI, have an increased chance of developing PF.
Lifestyle and occupation – Prolonged periods of standing e.g., at work, in a shop or factory, and sporting or recreational activities that place high demands and stress on the fascial tissues can contribute to PF.
Foot/ankle/leg mechanics – The way we walk, stand, run, or our foot type (flat feet, high arched foot, bunion, tight calf muscles) can lead to stresses in the foot that can cause trauma or irritation to the fascia.
Myth buster on heel spurs
Research dispels the fact that there is a direct relationship between the presence of heel spurs and the pain experienced with plantar fasciopathy, as we have believed for so long.
In fact, evidence suggests that people with large heel spurs report a greater improvement in pain and function after treatment.
How do I treat and manage it?
A conservative approach is usually the first line of treatment. The RICE protocol is a simple self-help guide that can be useful at home – Rest, Ice, Compression and Elevation.
Here are some self-help tips...
- Rest and elevate the foot as much as possible – stop all sporting activities that place excessive stresses on the plantar fascia, and swap to upper body work until the fascia recovers.
- Wear a bandage or tubular-grip to support the foot.
- Massaging the fascia e.g., with a golf ball.
- You can apply a local non-steroidal anti-inflammatory medication such as Ibuprofen gel to the affected area.
- Ice therapy to help with any inflammation and pain – rolling a cold can or a bottle with ice covered with a cloth, over the bottom of the foot for about 10-20mins.
- Wearing a heel raise in your shoes will reduce the pressure on the Achilles and calf muscle if they are tight.
- Wearing good supportive cushioned shoes with a slight heel, and insoles to shift the weight off the plantar fascia. Shoes should have a fastener such as a lace or strap to keep the foot in place.
- Not walking barefoot on hard surfaces or wearing flip flops, backless sandals, high heels, or flat shoes.
- Weight loss, by following a healthy diet and lifestyle.
- Regular stretching of the calf muscle and plantar fascia, see diagrams below.
When should I seek further help?
If you do not see an improvement in your symptoms within 2 weeks after initiating the self-help protocols, see a podiatrist, physiotherapist or your doctor for further advice and input.
Depending on your presentation, the clinician may decide to introduce other interventions such as bespoke insoles and taping to support your foot, shock wave therapy, stronger pain relief, steroid injections into the heel or explore a surgical approach in extreme cases.
We see several cases at the clinic, so if you are still struggling, don’t suffer in silence, contact the clinic for a consultation to see how we can help you. Treatment and management will be tailored to your needs.
To find out more or for an initial consultation, call The Vale Clinic today on 0118 304 9389