Originally published on 29 September 2015
It’s also known as plantar fasciitis, with the official medical term being plantar fasciopathy.
A recent study found that for every 100 people presenting to their GP for heel pain, only 12 get referred to the podiatrist. The remainder are given anything from general advice or counselling, to being referred for cortisone injection and physical rehabilitation.
This is alarming, as it still shows limited awareness of podiatrists being the specialists in heel pain.
I am going to let you know some key facts about your heel pain, as recently in the clinic I have had some of the following questions and scenarios.
For those who are going through menopause, does this influence your heel pain?
The answer is Yes! Oestrogen levels decrease during menopause, which causes biological changes in tendons. This means your tendons have less tensile strength, affecting their biomechanical capacity. So although your physical activity levels may have remained constant, menopause may affect the strength of your tendons. The weakened tendons are now unable to cope with the same level of activity. This may be contributing to the formation of heel pain or exacerbating it.
If I am older or overweight will this affect my ability to get better with heel pain?
Along with menopause, aging and increased weight do affect the tendons’ structure. For those with greater weight, this has been associated with having heel pain and may be a risk factor for its development. Nevertheless, recent studies have found that being older or being overweight will not limit your ability to reduce your painful symptoms.
Choosing comfortable shoes is difficult with heel pain, why is that?
The way the shoe fits and how comfortable it is, whilst also being able to have several pairs (a choice), is difficult for those with heel pain. Recent evidence suggests people with heel pain find it difficult finding footwear that may reduce the stress on the heel, thus reducing the pain. This may be due to the cushioning (mechanical) properties of the shoe itself. It was also suggested that people who avoid that part of a painful heel when walking have even more difficulty finding shoes.
I recommend two key footwear features to my clients in the clinic. These include having a stiff heel counter (the back of the shoe around the heel) and a stiff midsole at the heel. I recommend these two key points as it allows the foot and ankle to be locked in the shoe; the foot is unlikely to be sliding around. You will almost always find these in a good quality running shoe or walking shoe. Footwear choice is a little bit harder for females requiring a dress style shoe for work, however they do exist.
Another benefit when finding shoes with these properties is they almost always have some sort of decent cushioning and provide a good fit. Therefore, they are more likely to reduce your pain. It is common to experience increased pain after taking the shoes off (barefoot), as you have now removed that cushioned barrier. I encourage people to wear their supportive footwear constantly until their pain levels have started to reduce.
What homework can you do to manage your heel pain?
It is emerging that heel pain is more like other tendon problems such as Achilles tendinopathy. These tendons are showing biological changes in the tissues that include degeneration.
What does this mean for heel pain?
This means we need to put some focus on rehabilitation. When I explain why this is important for my clients, it usually goes like this. Imagine your plantar fascia is like a rope. The middle 1/3 of the rope has degenerated and is causing pain. The remaining 2/3’s of the rope is now having to take on the whole load (body weight), however, it’s not strong enough thus the pain is not getting better. We need to start rehabilitating the plantar fascia through exercises, which increases its ability to carry more load.
How do we do this?
By applying a graded load through the tendon. In simple terms, it is as simple as rising up onto your toes on both feet. As these start to get easier for you, progress onto one foot. The technique of these exercises is important. I am fortunate that I have big mirrors in the clinic that I can correct my clients if they are not doing them right. Click here to view how to do the exercise.
Take away point!
I cannot stress that treating heel pain is multimodal, meaning it is not usually just one thing that causes it to improve. I apply a variety of manual therapy techniques in the clinic such as dry needling, low-level laser therapy, joint mobilisation, strapping and orthotic therapy. How these things can help heel pain is another blog topic! However, it is something that I include in the management plan for all my clients.