Chronic plantar heel pain, plantar fasciitis, jogger’s heel…Call it what you will, persistent heel pain is one of the most common sports injuries affecting runners.
Heel pain can be debilitating and severely hold you back from activities you love.
Our team of expert Musculoskeletal Podiatrists at Podiatry First in Bondi Junction and Sydney CBD can help you recover quickly.
What is the “Plantar Fascia” and what is its function?
Your plantar fascia is a thick fibrous band of connective tissue similar to a tendon and ligament, originating on the bottom surface of the heel bone and extending along the sole of the foot towards the toes.
Your Plantar Fascia acts to prevent over flattening of the arch of the foot, and also stiffens the foot when taking off during walking and running.
It is crucial to the proper function of the foot.
What is plantar fasciitis or chronic heel pain?
The common and frequently used term “Plantar Fasciitis” refers to the long held assumption that it is the direct result of an inflammatory process. However this belief has been challenged, and it has been found that the condition is not primarily inflammatory and is in fact the result of degenerative changes at the origin or enthesis of the plantar fascia at the heel, including a deterioration of collagen fibres, increased secretion of ground substance proteins and increased vascularity (Jarde et al., 2003; Lemon et al., 2003).
Chronic plantar heel pain usually presents as pain under your heel or in the arch of your foot in the morning or after resting.
Quite often your symptoms will be worst with the first steps you take in the morning and improves with activity, as it warms up.
The prevalence in the general population is estimated to range from 3.6% to 7% (Dunn et al., 2004; Hill et al., 2008), whereas plantar fasciitis may account for as much as 8% of all running related injuries. (Lysholm & Wiklander, 1987; Taunton et al., 2002).
What causes chronic heel pain and what are the risk factors?
Activity: Sports that place excessive stress on the heel and attached tissue e.g. running, ballet and aerobics. Especially if you have tight calf muscles or a stiff ankle/big toe from previous activity.
Weight: Carrying around extra weight increases the strain and stress on your plantar fascia. Body mass index (BMI) in the general population and the presence of a calcaneal heel spur are the two factors found to have an association with plantar fasciitis according to a Cochrane review by Irving (2006). A BMI of 25-30 kg/m2 approximately doubles the occurrence of CHP, and it triples if passive ankle joint dorsiflexion is less than 10°. It increases by 3.6 times in weight bearing occupations (Sahin et al, 2010).
On your feet: Having a job that requires a lot of walking or standing on hard surfaces, for example; factory workers, teachers and waiters.
Footwear: Wearing shoes with poor support increases the load through the plantar fascia.
Your foot structure: Flat feet or high foot arches where changes in the arch of your foot changes the shock absorption ability and can stretch and strain the plantar fascia, which then has to absorb the additional force.
Weak intrinsic foot muscles and poor foot control: Muscle fatigue, weakness and poor control can overload your plantar fascia and cause injury.
Reduced Ankle Mobility and great toe mobility: Reduced dorsal-flexion (upward movement) can increase the loading of the plantar fascia. The presence of a heel spur can identify that there is chronic excessive load going through the bottom of the foot leading to the development of chronic heel pain. Heel spurs can be confirmed by X-Ray.
Assessing heel pain
At Podiatry First our highly trained Podiatrists have the ability to diagnose chronic heel pain, through a specific biomechanical assessment. Your Podiatrist may refer you for an X-Ray to help identify a heel spur or an ultrasound scan or MRI to identify a plantar fascial tear, calcification or the degree of thickening at its attachment into the heel.
Your treating Podiatrist may further assess your running technique and functional movement patterns i.e. squat, lunge, jump and hop.
From this thorough assessment our practitioners can usually provide you with a clear diagnose, determine the cause of your symptoms and create a treatment plan to not only resolve and reduce your pain and symptoms, but address the cause and prevent it from reoccurring in the future.
Treatment for chronic heel pain, may consist of but is not limited to the following:
A study by Radford et al (2006) was able to demonstrate that when used for the short-term treatment of plantar heel pain, low-dye taping provides improvement in ‘first-step’ pain compared with a sham intervention after a one week. The aim of low-dye taping is to support the arch of the foot, improve foot posture and reduce stress on the foot and lower limb during activity.
Custom Foot Orthotics:
Custom foot orthotics have been shown to be effective in both the short-term and long-term treatment of pain. Improvements in function, foot-related quality of life, and a better compliance suggest that a foot orthotics are a good choice for initial treatment to treat plantar fasciitis (Roos et al 2006). Upon review with our Podiatrists, an assessment will determine the need and benefit of orthotic intervention. To assist your symptoms and improve your foot and lower-limb biomechanics, custom orthotics can be made.
Shockwave therapy has become the gold standard in chronic heel pain treatment. This treatment works by sending pulsed waves of high intensity sound into the body. It elicits the bodies regenerative capabilities at laying down collagen at an accelerated rate to quickly heal injured tissues. PodiatryFirst is recognised as the industry leader in the use of shockwave therapy for a range of soft tissue conditions. We have found it very successful in resolving chronic heel pain.
Your Podiatrist at PodiatryFirst will design and administer an appropriate program of shockwave therapy to dramatically speed your recovery.
High Load Strength Training:
Recent research by Michael Rathleff and associates has highlighted the benefit of high load strength training. Rathleff concluded in his study that ‘a progressive exercise protocol consisting of high-load strength training, resulted in a superior outcome at 3 months compared with plantar specific stretching and may aid in a quicker reduction in pain and improvement in function’. The high load strength protocol is individualised by your expert Podiatrists, to ensure appropriate loading of the plantar fascia, this will include a specific number of sets, repetitions and load.
Additionally, through your biomechanical assessment, your treating Podiatrist may have highlighted altered lower-limb biomechanics, including poor foot control and intrinsic foot strength and/or poor hip and lumbo-pelvic control. Exercises may also be included to help address these factors in the form of a home or gym based program.
Calf muscle stretching is frequently prescribed for chronic heel pain.
Specific stretching for chronic plantar heel pain has been shown to be more effective than traditional weight bearing calf stretching. Three randomised controlled trials have now shown the effectiveness of plantar fascial stretching (Rompe 2010, DiGiovanni 2006, DiGiovanni 2003). Podiatry First have found that specific stretching is an important part of treatment and is shown to have similar long-term effects to high-load strength training.
Our Podiatrists will discuss the techniques and specific stretching protocols with you.
Take home messages:
- Early protection and pain relief. It is important that you decrease or avoid activities that cause your heel pain to increase.
- Above all – consult with our Podiatrists to accurately diagnose your condition, identify the cause and aggravating factors and to prescribe a customised treatment plan.
Get back to your activities sooner and stop missing out on what you love doing, we can help you.
CLICK HERE to organise an appointment to discuss your ankle pain. Take a step in the right direction. Speak to one of our Podiatrists to get you back to the activities you love!
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