In this weeks episode, Tony talks about heel pain – what it is, how it happens, how to treat it, and how to get back to a pain-free state.
It’s one of the more common complaints he sees at Morley Physiotherapy Centre, and Tony has taken the time to give you all the inside information on diagnosis, causes, symptoms, risk factors, and treatment.
Full transcript below!
Heel pain is one of the things that we see often in our clinic, and it’s one of the areas of soft tissue injury that once you develop it, it can take quite a while to recover. So I think it’s important that we understand early when it’s appropriate for us to get it treated and get it sorted out to avoid that long-term problem.
What is heel pain?
Well, usually, heel pain, particularly pain under the foot, is caused by an inflammation of a thick band of tissue under the foot called the plantar fascia. It runs basically from the bottom of your foot and it connects to your heel bone to the toes. As you load the foot and as the foot flattens on the ground, the plantar fascia becomes stretched and loads. And over time and repetitive use, this can cause some microscopic injury tearing of the tissue and results in inflammation and pain.
What are some of the causes and risk factors regarding plantar fasciitis?
Well, first of all, it can affect people that are active and sports-minded, particularly people that do repetitive, loading activities in dance, aerobics, ballet, and running.
Also, people that make any changes in their exercise programme, particularly changing from one sport to another, or going from one season, on season or off season, and loading the foot unexpectedly can cause problems.
If we’re overweight, the extra load of body weight causes more pressure on the heel area on the foot. And that’s one of the things that’s a factor and we should consider as well.
If our jobs require prolonged periods of standing or landing off a high to low area, like example truck drivers that jump on and off trucks, this puts tension on the actual tissue under the foot.
If we have a chance in lifestyle, particularly people that go on holidays and people that go touring, they usually get off on a lovely holiday, they do lots and lots of walking, meaning around they don’t usually do. If you’re doing a change in lifestyle where your walking and standing periods are increased suddenly and it’s for a prolonged period of time, that can cause an overload on the tissue.
Some of the actual structural things that we should look at, as well, are your feet, particularly if you have flat feet or high-arched feet, or if you’ve got poor foot function which causes rolling or pronation. And this causes walking faults on patterns on the foot, this causes pressure on the fascia.
Research also tells us that diabetics and people with arthritis can also develop problems in this area.
What are some of the symptoms that you can experience here?
Well, first of all, it’s pain. And the pain’s located very locally, anywhere between the heel bone and the ball of your foot. I think the foot-arch pain is less common than the heel pain. It’s also the timing of the pain. It’s very intense but only short lasting. Usually, it occurs with the very first few steps in the morning after rising from bed. But the pain reduces once the foot loosens up, but may return after long hours on your feet, or if you’re getting up after a prolonged period of time in a sitting or lying position. So pain’s intermittent, it comes and goes, and it usually follows inactivity.
The clinical diagnosis is based on the history, the symptoms, and the examination findings. And that is usually done by your physiotherapist or your podiatrist or your doctor.
Sometimes medical tests are required to diagnose as well if the cases are longstanding or severe, and X-ray ultrasound scans and MRIs can be used to examine the tendon, the bone areas around the tendon as well.
In chronic cases, the area of the tendon that inserts onto the heel bone can become quite fibrous, quite lumpy. And in some cases, the bone area becomes reactive and calcification forms at that point. And if that gets picked up on an X-ray it’s called a heel spur.
Now, it’s interesting to note that it isn’t the heel spur or the bone that’s painful. It’s the inflamed tissues that attach to it.
How to treat heel pain, heel spur or plantar fasciitis?
Well, first of all, I’d recommend ice treatment. And obviously, if you can get a plastic water bottle, fill it with water, and put it in the freezer, you place that on the ground and then with your foot arch resting over the bottle, you roll the bottle forwards and backwards between your heel and the ball of your foot.
Stretching is important, particularly of the calf muscles, which are usually very tight, and of the actual foot arch muscles. And these techniques are easily instructed to you by your physiotherapist.
But a couple of tips for home that can give you a lot of help is when rising from bed in the morning, place a tennis ball under the foot and roll it gently forwards and backward under the arch of your foot, and also roll it in a circle clockwise and anti-clockwise. And do this for about 15 seconds for each one. And repeat it on both feet. Then, before you rush off to the bathroom, put on your soft slippers. Anything soft under your feet in the morning is amazingly relieving for your foot pain. I think if you could do these three tips, in the morning on rising and a couple times during the day, you’re going to find it’s going to really help you.
The other thing to look at is your footwear. If you’ve got shoes that have got arch support in them or cushioning in them, your foot and heel pain is much better. So if you need advice on your footwear, speak to your physiotherapist, speak to your podiatrist. And they can give you not only appropriate footwear but any other insoles or cushioning devices that can help relieve some of the contact or pressure pain under your foot. Some cases even require insoles. And these insoles can be off-the-shelf, or they can be custom-made by your physiotherapist or your podiatrist.
So I wish you well. Hope the information I’ve given you today will give you a bit of a help. If you need any further advice, call us at Morley’s Physiotherapy. We’re always willing to help. And if you can feel well, move well, and live well, I’m happy for you. All the best.
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Western Australia 6062
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