OUCH!! My Heel Hurts!!
Heel pain, policeman’s heel, plantar fasciitis… whatever you choose to call it. It is a common condition that can really impact on your day. In clinic, I see at least one person every day who is complaining of heel pain which limits or severely impacts their daily activity.
So…. what is it?
Our foot is a complex structure made up of 26 bones and many tendons and ligaments. The structure encased on the plantar aspect (bottom of the foot) by a tight band called the ‘plantar fascia.’ The band spans the length of the foot from its main insertion at the heel, to the many insertions it makes at the toes. Injury to this band causing pain is called ‘plantar fasciitis’ (PF).
PF is caused by an overload of stress to the structure. The feet support the weight of our whole body and allow us to move. The injury can be caused by different factors in different people and can either be chronic (long term) or acute (sudden onset). Understanding why it happens can ensure you get the best treatment for your condition.
Imagine the plantar fascial band is like an elastic band. With every step that you take that elastic band stretches and contracts. This pressure as you go about your daily tasks can cause a small inflammation at the insertion, then as you carry on ‘stepping’ this causes more and more micro trauma to the area. This results in pain and inflammation over a long period of time.
A change of activity or footwear puts a vast amount of pressure through the band of fascia causing overload and injury.
In chronic PF, the pull of the plantar fascial band on the heel bone (calcaneus) can cause the bone to ‘over heal’ itself and causing a calcification around the insertion point of the band.
What causes it?
Many different factors can cause PF, and causes vary from person to person. Essentially the cause always has a biomechanical root, i.e. the foot is not functioning optimally for the task that it is trying to carry out.
Common causes are:
* overpronation/ “flat feet”
* incorrect footwear
* muscle tightness in the calf/hamstring muscles groups
* muscle weakness in the foot
* change of activity e.g. taking up a new sport
* weight gain
* climbing ladders/carrying heavy objects
Treatments can vary from person to person. Every person with PF can benefit from a biomechanical assessment with a podiatrist. This will look at how your feet function on their own, and in relation to the rest of the body. Following on from this the practitioner will often:
These are specialist insoles which are worn inside your shoes and help to ensure the foot functions correctly.They also help to hold your foot in an ‘at rest position’ meaning pressure is relieved from the area.
Stretch and strengthening programme
Calf stretches are important in every person suffering with plantar fasciitis. If the calf muscles are elongated, this releases the upward pull of the calf muscles on to the heel so can ease the restriction.Strengthening of the muscles that support the arch is also important.
Ice and rest
It is important to rest the area – so this may mean a break from your sporting activities as much as possible, and to not continue through the pain as this can do further damage and mean treatment takes longer.Also, aim to Ice the area 1-2 x daily.
Taping and strapping
Kinesio tape can be very affective in helping to alleviate the pain caused by PF.Zinc oxide tape may be used to strap the heel in certain cases.
Soft tissue and joint mobilisation
When we have pain, our body ‘tenses up’ and therefore movement is restricted.With restricted movement you can then have ‘new pain’ as the foot function is impaired. By mobilising the joints and soft tissues, the foot can function optimally. The blood flow can improve which also means healing is accelerated.
Ensure sports shoes are always fitted correctly in a reputable sports shop.Bring a selection of footwear to a biomechanics appointment so that the podiatrist can give you advice on what footwear is best while you recover.
You should aim to roll your foot on a golf ball or frozen water bottle daily to try and release muscle pressure in the area.
But Remember! Each patient is different and each person will take different lengths of time to recover, some recovering quickly, some taking a bit more work. This is the same with any injury, but patience and perseverance are the key to success.
If you have any questions, please call the clinic to speak to me.