PLANTAR HEEL PAIN

Plantar heel pain, plantar fasciitis​, plantar fasciopathy

 

It goes by many names, but plantar heel pain affects 9.6% of the population (Thomas 2019), and will leave the sufferer hobbling to get out of bed, and if not managed correctly, result in time away from running. In this article we discuss what is plantar heel pain, & what can be done to manage it

What is the plantar fascia?

The plantar fascia is a thick ligament that runs from the heel to toes, and its main function is to stabilize the medial longitudinal arch of the foot. Interestingly the plantar fascia connects with the Achilles tendon so there is an important relationship between the two (read more about Achilles tendon here).

 

When the plantar fascia becomes overloaded, it can become painful, resulting in plantar heel pain.
 

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What are the symptoms of plantar heel pain?

 

The pain is typically felt underneath the heel and slightly on the inside, but some people will experience pain travelling down the foot.

The pain is usually aggravated with prolonged weight-bearing on the foot (standing, walking or running), or felt after standing after periods of prolonged rest (often when getting out of bed in the morning, or after sitting).

Image: https://en.wikipedia.org/wiki/Plantar_fasciitis

What else could it be?

It's important to get a DIAGNOSIS of your heel pain, as there are a number of potential other causes including:

  • Fat pad irritation 

  • Nerve involvement

  • Calcaneal stress fracture

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Is it a heel spur?​

 

Heel spurs are actually quite common, with 12% of the population having one. (Moroney et al 2014)  Heel spurs are more likely seen in those with a higher BMI, osteoarthritis, or lower limb pain. Whilst having a heel spur means you are more likely to have pain, the spur itself does not necessarily cause pain.

 

To read more about heel spurs, head here 

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Managing plantar heel pain

 

Firstly get a DIAGNOSIS from a health practitioner who deals with runners! It’s important to know exactly what has been injured. Once you have a diagnosis, then get a PLAN moving forward! A thorough assessment will ensure that treatment and rehabilitation can address any issues identified, and reduce the chances of you suffering another injury, and get you back out there as soon as possible.

It’s vital to see your health practitioner to firstly assess and diagnose your problem and secondly to create an INDIVIDUALIZED rehabilitation program.

Here is an example of some of the things that we will get patients to do optimize recovering from plantar heel pain:

What is our unique approach to plantar heel pain?

  • At Health & High Performance we pride ourselves on a thorough examination to ensure an accurate diagnosis to then lead to targeted treatment, allowing you to get back to sport as soon as possible.

  • Firstly it is important to have a thorough discussion about your problem and some of the factors that may have contributed to it. This can include training errors (doing too much too soon & inconsistent training) or insufficient recovery (ie. high stress and poor sleep).

  • Using our state of the art technology, the AxIT system, we are able to measure calf & foot strength to assist in predicting and guiding return to play. Read more about the AxIT system here.

  • Consideration of the role that other areas played in your injury: for instance, foot strength, low back pain, hip problems, or even previous ankle sprains may contribute to your injury. Your examination with us will cover all these areas, and your management plan will include solutions to these additional issues.

Rehabilitation & return to sport

“Every injury is unique, treatment should be too”

  • Immediately commencing rehabilitation: from Day 1 there will be exercises you can perform to hasten your recovery. These exercises are prescribed according to criteria (what you can/can’t do) not just based on time. In a 2017 study by Bayer et al, they compared commencing rehab at 2 days versus 9 days, and found that those starting rehab 1 week earlier, returned to their sport a staggering 3 weeks earlier! Click here to read more

Below is a guide of some exercises that can be used for rehabilitation of plantar heel pain. Your sports chiropractor should individualize these exercises after a thorough assessment.

Stretching or strengthening?

Fortunately, there are various effective treatment options for plantar heel pain, two of which include strengthening & stretching. In our blog here we discuss the PROs & CONs of each

Foot strength exercises

Your feet are your foundation, and the importance of foot strength in plantar heel pain can not be underestimated.  In their 2016 study, Cheung found intrinsic muscle volume decreased in runners suffering from plantar heel pain vs healthy matched runners. Foot strengthening can help reduce the load on the plantar fascia.

Some exercises seen in this video which can be used to strengthen these foot muscles include:

Plantar heel pain_ to stretch or strengt

Calf strengthening exercises can also be beneficial for plantar heel pain. A combination of gastrocnemius & soleus exercises often work well.

Gastrocnemius biased exercises

Exercises that target more the gastrocnemius muscle can be seen in the video below.

These exercises include:

Soleus biased exercises

Exercises that target more the soleus muscle can be seen in the video below.

These exercises include:

Plyometrics

Progression to plyometric exercises is very important for plantar heel pain recovery. In the video below we discuss some of the plyometric exercises that can be used.

Taping for plantar heel pain

Need further help?

Please don't hesitate to contact us for a thorough assessment of your plantar heel issues & to formulate a plan to get you back to health & high performance!

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