Is Heel Pain Stopping You Doing What You Love ?

This blog will explain heel pain, the causes and treatments options. If you are suffering we can help. Heel pain is a condition that affects many people and we podiatrists have the expertise in foot problems; we understand the complex anatomy of feet and know how feet work. We understand the impact your feet can have on the rest of your body. So any foot or function related issues then your first port of call has to be a podiatrist.

Heel Pain a common condition that affects many people. A quick internet search (yep we all do it) says that up 10% of us are suffering from heel pain at this moment. it is often debilitating and stops you form doing what you love to do. It usually affects people who are more active – either with work or hobbies / activities. It is a common condition that we see regularly in clinic and we know how frustrating it can be to overcome and how it can impact your life.

There are various conditions that present as heel pain and there are a number of different treatment options. The really important thing is to make sure you are using the correct treatment for your type of heel pain and at the right time of the healing process. This is important because as your condition improves you are likely to have to change how you are managing it. It can be a complex subject and I shall try and explain some of this here. Importantly if your foot pain is impacting on your work or leisure activities there is treatment available and we can offer assessment and treatment to help you on your way.

Although there are many types of conditions that result in heel pain, treatment will often be very similar as they are repetitive strain injuries. The most common types of conditions are when the bone or soft tissues have been subjected to more load then they are happy with and have been damaged. This could be a one off event like dancing at a wedding or a more gradual build of load over a period of time. This could be training for a marathon, walking more in sandals on holiday or embarking on a new job or activity that involves more time on your feet.

It can also come on if you have reduced your activity for a time as well. It is very frustrating as it often stops us in our tracks and we are not able to carry on doing the things we love to do. Our bones and soft tissues do not like it when we subject them to loads that are different to what they are used to. We then experience pain and have to do something about reducing these damaging loads.

Usually we respond to the pain (that is what it is there for) and back off a bit and the issue heals up and we are able to carry on. But if we are starting a new job, training for something or out and about on holiday we might not be able to do this or, often we choose to ignore the symptoms – this is fairly common. The pain can also come on fairly gradually and we may not be aware of how bad it is until it really stops us in our tracks.

Watching the sunrise over the Hope Valley

Watching the Sunrise over the Hope Valley – enjoying time on our feet is fantastic and foot pain can limit how much we want to do this.

Plantar Fasciitis

Plantar fasciitis is the most common type of heel pain that we see in clinic. This is what most people think they have once they have done an internet search or seen their GP. Most often just one foot is affected, but some unfortunate people, have it in both feet. Plantar fasciitis usually presents with pain in bottom of the heel when first standing. First thing in the morning is often the most painful time, limping to the loo or down the stairs is a common statement from people. The foot has been rested over night and then complains when it is stood on getting out of bed. It can also be painful when first standing after a period of rest during the day. Often getting out the car when returning from a walk can be uncomfortable.

So what is plantar fasciitis?

The plantar fascia is a big thick band of connective tissue that runs down the bottom of the foot and bridges the gap from the ligaments that attach the toes to the foot at one end and attaches to the central area of the heel at the other end. It sits just under the skin and below it are some muscles that follow the course of the plantar fascia and also attach into the heel bone. The plantar fascia has two major functions; to support the muscles supporting the foot at loading and help stabilise the foot as we move into the push off phase of walking or running. So it is stretched and loaded at contact and shortens as we bend our toes and walk past our foot at the push off phase.

The problem occurs when the loaded, stretched plantar fascia is loaded and stretched for too long in the stance phase. So instead of the arch reforming and the arch and plantar fascia shortening, the arch continues to lengthen as we lift our heel and our body weight moves onto the ball of the foot. This, either, stretches the plantar fascia further, or keeps it fully stretched out. As our heel is off the floor, all of our body weight is suspended on the plantar fascia. The repetitive nature of this action can start to cause damage to the plantar fascia, usually at the point just in front of the heel bone as in the picture above. So if your foot functions in this way, and some do quite happily, but you have a change in activity then issues can start to occur.

It Can Creep up on us

This is often why there is a gradual increase in discomfort, sometimes over months. The damage is usually quite small but is not allowed to fully heal as we are always using our feet. The discomfort builds and we start to notice the pain more often, not just when we get up out of bed. It can be felt after any period of resting or when undertaking prolonged activity on our feet. We are more likely to be at risk when we are starting a new activity such as sport or job that involves more time on our feet.

Clinical Assessment

When we see you in clinic we shall undertake a though assessment of your problem and ask you about anything that may have contributed to the problem. This could be months before your started to notice anything. We shall look at your feet and try to identify what structure is causing the problem. This is to ensue we have the correct diagnosis, the amount of damage that is present and any compensatory factors or pain. We shall then look at the way your feet move, how they respond to standing and walking. We will then discuss with you what we think is the problem and why it has occurred. Following on from this will be a discussion about which treatments are available and which we feel will be most beneficial to you at this time.

Healing plantar fasciitis is a long process and you may need to change your treatment according to the phase of your treatment.

Assessment may include walking on a pressure mat or video analysis if we need more detail.

Ultrasound Scanning

Before fully embarking on treatment we may suggest you have an ultrasound scan. The aim of this is to understand the amount of damage to the plantar fascia and if the level of inflammation occurring. This can be really helpful if there is a sudden onset to identify either rupture or tears. The scan can also show the thickness of the plantar fascia. Ideally this should be 3-4mm thick but in chronic cases it can swell to 8-10mm thick. We can also see if there are blood vessels growing in the plantar fascia or areas of damage such as cysts or fibromas. During the scan we shall also look around the area for anything that may be contributing to the problem.

Here is a link to more information about scanning

Services – Colpod therapy (colpodtherapies.co.uk)

Treatment

There are a number of treatments available and these may change as the issue heals up. We shall try to outline what we think will happen at the assessment but sometimes healing goes faster than we think, or it may be slower.

For most people reducing the pain is important so you can get back to normal life. But we must remember that pain is our bodies way of protecting us from causing more damage. So we don’t recommend that you take regular pain killers. These can mask the symptoms and you may still be doing more damage but not getting the feedback. There is also growing evidence that tables such as Ibroprofen may interfere with the bodies natural healing processes. If you are in a lot of pain after a walk or time on your feet then take something to help ease the discomfort but try not to start to become dependant on pain killers.

There are some things that you can do to help reduce the pain without taking painkillers. Pain can be reduced with massaging the arch of the foot, stretching out the calf muscles to reduce tension in the lower limb, hot and cold contrast foot baths or sensations. Use a cold pack and warm hot water bottle for example and alternate placing painful foot on each for about 30 secs to 1 min for 10 mins. Sometimes soft shoes such as Crocs or sandals, sometimes going bare footed can feel good in the house. Using the spikey massage balls can be helpful and can be used when sitting or standing.

Help Yourself

The important thing – easier to say than do I know – is to limit the time on your feet in any one go. Plantar fasciitis is a repetitive strain injury. So the more we load it and more it will complain. But there is a good case for keeping moving on it. Stopping completely is not always recommended but moderating activity – I know easier said then done – is really helpful. Time on feet is the problem, there will be a limit to how much you can do.

Often we find that first standing is painful, then as you get moving the pain reduces – it may not totally disappear, but it usually reduces. If you keep walking for long enough the pain starts to come back. It is this second lot of pain that needs to be avoided if possible. This is where the damage will take place, either directly to the structures or to the compensations that your body is using to keep going. Try to avoid doing too much in this second lot of pain. If possible get off your feet, do some stretches, massage, hot / cold contrasts, anything that helps reduce the pain and tension in your legs and feet. Then get up and move again.

Home Treatments

As we have just discussed; things to do at home for yourself.

Try to modify your activity to reduce the time on your feet in one go.

Massage with hands or foot massagers into the arch of your foot, not directly into the heel but further down towards your toes. Stretch toes up and down also feels good. The arch become tight and we need to help it relax.

Stretching feet and calf muscles. The muscles in the back of your leg work overtime to help your foot. They become tight with having to protect your foot. So some gentle stretching can help to reduce this tension. Sitting with your feet out in front of you with a band, scarf or belt around your foot and then pull your foot up towards you and then push your toes away. So use the calf muscles to push your toes away – as if you standing on your toes, and then stretch your foot back towards you. 10 times have a rest and then go again.

Foot massage ball and stretcher

Standing up, feet facing forward, relax body and bend knees forward as if going into a small squat forward. You need to move at ankles and knees, not hips – so a low squat. Again stretching feet and calves. If this feels ok, when in the down position, raise up onto toes and then drop down on flat feet. Only do this last bit if you feel balance is good and feet will take it.

Last one, and the hardest one, so only do it if your feet are feeling stiff and not acutely painful. Stand on a step and lower heels down, both feet together, feet facing forward and hold on. It is a gentle passive stretch. Raise up level or higher and lower again. 5 max, stop have a little walk, go again for another 5. Start gently and build up. Don’t over do this one. It is a big stretch for the plantar fascia, treat it with respect. If it feels as if it is hurting your foot, stop.

Hot and cold contrast exposure. Warm hot water bottle and cold pack, alternate placing foot on each one, 20-30 secs on each. It alters the sensation into the foot and can help relax the muscles. Gives the foot something else to think about. 5 mins max.

Alternate all of the above when resting feet. They will all help a bit each. Not one of these things will cure the problem, but they will all add a little to the rehabilitation and recovery.

Clinic Treatments

In clinic we can offer a variety of other treatment options.

Manual therapy

We use hands on techniques for massage feet and calves or mobilisations of the foot and ankle joints. These structures can be stiff and tight due to holding feet. This can affect how the plantar fascia moves. Mobilisations of these joints can help the feet feel more comfortable and work more efficiently.

Manual therapy on a tight ankle to help the ankle and foot move

Insoles / orthoses

These help take away some of the movement in your feet. If the arch is dropping too much then these can reduce the amount of movement and reduce the loading on the plantar fascia. They can also be used to help the foot work more efficiently and help the plantar fascia work correctly at the correct time. The orthoses can be premade where we find the best fit or custom made to your foot shape. We also may advice on padding of the heel with gel supports.

One of the custom orthoses to help with heel pain
A selection of insoles that we could use to help

Footwear advice

Wearing the correct shoes goes a long way in helping overcome symptoms. We can advice on suitable footwear.

Shockwave therapy.

This is a treatment that uses shock waves fired into the area to help promote your bodies own natural healing. It stimulates tissue damage without causing damage and so your bodies own repair system is activated. it can be uncomfortable but doesn’t need to be painful. A course of treatment at weekly intervals is often the best to use it. We get great results with shockwave for patients that have had plantar fasciitis for many months, it helps get things moving and healing.

Shockwave treatment for heel pain

Injection Therapy

We either use steroids which are a great pain killer and so give relief to very painful problems. This can be enough to help get the feet moving but you have to be careful not too do to much as you will not be getting the correct feedback if you are damaging the tissues.

We also can use platelet rich plasma – which is where we take a small amount of your blood and spin it to separate the components then inject the good healing parts back into the tissues. This works as a pain killer but brings all the healing ingredients directly to the right place. Both of these injections are carried out under guidance of ultrasound so we know we are hitting the right spot.

Filling the syringe with centrifuged platelet rich plasma for a heel pain injection

Here is a link to our treatments page

Treatments – Colpod therapy (colpodtherapies.co.uk)

Summary

So there is an overview of our approach. Plantar heel pain is a pain and can be frustrating. It can be slow to show progress to start with and a complicated thing to heal up as there are often many factors involved. The assessment is important so we can identify what is the structure damaged and what has caused it. Then we can discuss treatments. There are many available and often a combination is needed to be used. Plantar fasciitis, the most common condition, is a repetitive strain injury. We need to reduce the damaging strain, still keep you moving, address the reason why you have strained it and plan so it doesn’t come back again.

I hope this has been useful and please contact us if you feel we can help.

Call 1246273848

Here is a link to our bookings page if you want to book with us. Book a biomechanical assessment for an initial assessment for us to see what is going on.

Colpod Therapies – Book appointment (cliniko.com)

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