Assessing Your Heel Pain


Assessing Your Heel Pain

Plantar fasciitis – The Basics

Plantar fasciitis (pronounced: plantar fash-ee-eye-tiss) is the most common cause of heel pain. This injury is a result of inflammation or injury of the plantar fascia. The plantar fascia is a thick band of tissue located on the bottom of the foot which supports the arch. Symptoms of plantar fasciitis could include a pain sensation (burning, aching, sharp or stabbing), pain located in heel and/or arch, and increased pain in the morning due to the tightening of the area that occurs overnight. Those individuals most prone to plantar fasciitis are 40-60 years of age, females, and individuals who have inadequate arch support (flat feet or high arches), do excessive amounts of standing (teachers, factory workers) and/or running, or are overweight. This condition can occur in one or both feet, and typically had a slow onset that gradually worsens. Complications of plantar fasciitis can include a chronic condition and changes to ones walking mechanics.


Treatment and Prevention

Treatment and future prevention plantar fasciitis begins with choosing the proper footwear. Sneakers should provide adequate shock absorption and cushioning, foot and ankle motion, and arch support based on your individual foot qualities. Thin soled shoes and footwear lacking proper support (flip-flops, high heels) should be avoided as much as possible. A health care professional can make recommendations for an arch support that can be slid inside of your shoe, in the form of orthotic inserts or heel cups. These devices will allow for a more efficient distribution of weight, appropriate cushioning, and proper foot mechanics. Arch taping performed by a physical therapist or athletic trainer can provide support to your plantar fascia, and relief from the discomfort.


Stretching and Massaging

A night splint can be worn to keep the plantar fascia and calf lightly stretched while you sleep, preventing tightening of the area overnight. To stretch the plantar fascia, pull the toes back on the injured foot until a stretch is felt in the arch. An additional option for stretching is sitting, legs straight, with a towel looped around the top of the foot. Pulling the towel towards allows a stretch to the calf and plantar fascia. Hold these stretches for 20-30 seconds for 3-4 repetitions. A massage can be performed to the plantar fascia by rolling a can or small ball from the tips of the toes to the heel, back and forth for 30-45 seconds.


Tips for Training with Plantar Fasciitis

While the “RICE” principle is always important to follow after injury (see previous article by clicking http://proexpt.com/content.php?l=73&pro=1&id=22), we understand the desire to return to athletic activity. Non-impact activities are excellent during the beginning stages of plantar fasciitis, when running is not an option. Try riding the bike, running on the elliptical cross-trainer, or jump in the pool for an aqua-jogging session. When returning to running activities, avoid excessive running by gradually returning using a 10% per week as a guide to increase time and mileage. Acquire proper training shoes which provide support and shock absorption, and it would be wise to purchase new sneakers after running in them for approximately 300-400 miles. Always allow for a proper warm-up and stretching period before activity, a cool down and stretch after activity, and maintain sufficient rest time between activities. Begin your running activities on a softer and flatter surface, before returning to a harder surface with hills.


How can ProEx help my Plantar Fasciitis?

While attending physical therapy, our staff will place our primary goal to promote healing and return you back to your prior activity level. We can instruct you on exercises to stretch the plantar fascia and lower leg, strengthen the involved structures, tape and brace the area as necessary, and make recommendations on appropriate footwear, splints or shoe inserts. Upon discharge from physical therapy, we will provide you with a home exercise program to prevent future episodes of plantar fasciitis.


Diagnosis of Heel Pain

After clinical examination in the office, your physician may want to perform additional tests to evaluate the cause of the heel pain. Such testing could include x-ray, MRI or diagnostic ultrasound. Not every case of heel and arch pain will be diagnosed as plantar fasciitis. Other potential causes of heel pain are listed below.
- Heel Spur – bony growth on the heel bone; can be a product of plantar fasciitis although not necessary to occur in conjunction for diagnosis
- Stress fracture – injury to the heel bone (calcaneus) due to overuse and stress
- Achilles Tendonitis/Tendinosis/Tear – injury to the Achilles tendon resulting in inflammation or tendon tears
- Lumbar radiculopathy – injury to the nerves in the low back which can cause pain down the leg and into the heel
- Sever’s Disease or Calcaneal Apophysitis – injury to the heel’s growth plate during adolescence
- Tarsal Tunnel Syndrome – nerve compression within the foot causing foot and heel pain

Assessing Your Heel Pain