An Article Written by Yen-Chii Wong
Podiatrist – New Step Podiatry
HEEL PAIN:
A PODIATRIST’S GUIDE
Two of the most common sites of pain we see as podiatrists are at the heel and arch of the feet. Pain in these areas can affect your ability to enjoy the activities you like to take part in. One of the first steps in treating your foot pain is getting a better understanding of what it is and why it has happened.
As podiatrists we often hear the same common questions about heel and arch pain, so we will answer some of them today.
Does having heel pain mean I have plantar fasciitis?
The short answer to this is… it depends!
This means that pain around the heel can be due to one or more of these structures. Sometimes the injury can even be to the heel bone itself. Podiatrists can help to identify the source of your heel pain. We can also refer you for diagnostic imaging if we think it is appropriate (imaging isn’t necessary for all cases).
Symptoms for the same condition can vary from person to person based on their lifestyles and activity levels. They can also be very similar for different conditions! This is when accurate knowledge of anatomy and function allow your podiatrist to better understand your heel pain.
How is pain in my heel related to the arch of the foot?
The structures that pass through or attach to the heel bone often continue to run along the bottom of the foot. Because our feet are dynamic (they are moving and rarely entirely still), it is possible to experience aching or soreness anywhere along the affected muscle or soft tissue.
I have flat feet and I pronate. Is this causing my heel pain?
Let’s set the record straight on ‘flat feet’ and ‘pronation’!
Having flat feet is an umbrella term for having lower arches and/or ankles that roll inwards. You may hear terms like ‘pronation’ associated with flat feet. Flat feet don’t need to be ‘fixed’ (you’re not broken!) unless they are a rigid deformity. Having flat feet also doesn’t mean you will definitely get heel or arch pain. Injury can happen when the soft tissue and muscles passing through the inside of your foot and from the heel are overworked because of excess forces going through this area.
So, pronation and flat feet aren’t the enemy! What is most important is to increase the strength and control of our foot and ankle and its ability to bounce back out of pronation before we push off. If we are unable to do these things efficiently muscles may be overloaded, and this is when heel or arch pain can occur.
I have a heel spur; do I have to get it removed to fix my heel pain?
The short answer is that it is unlikely you need to have your heel spur removed. Cecilia explains what a heel spur is, how they form, and what they mean in this blog post. We like to treat you and not your x-ray, and in most cases removing a heel spur may not address your pain.
If I just stop doing activity, will this fix my heel pain?
Your pain will most likely go away if you stop activity. But if that activity or exercise is something you enjoy, stopping it entirely isn’t something we want you to do. If you do stop activity temporarily and jump back into it with no rehab, the heel pain will most likely flare up again because of the sudden load through the area. The structures in your heel will be used to ‘resting’ and have had no preparation for more load!
Your podiatrist can work with you to modify your activity and manage the load as part of your heel pain treatment. In most cases you won’t need to wait for it to get better before getting back into exercise.
What can a podiatrist do for heel pain?
Your podiatrist will do a thorough biomechanical and musculoskeletal assessment, where we will gather information about you. This can include:
– Medical history (including any issues affecting your hips, knees, legs, ankles, and feet)
– Your activity levels
– Desired outcomes you wish to reach from seeing us
– Joint movement and muscle strength, both overall and specific to your injury
– Foot and ankle posture and behaviour with different movements
– Shoe assessment
– Gait analysis (using a treadmill or PodoSmart insoles)
How can a podiatrist treat heel pain?
Unfortunately, there is no ‘one size fits all’ approach to treating many musculoskeletal injuries (wouldn’t that make everything easier!). Treatments for the same condition can be different which is why what worked for your friend might not have the same outcome for you. Your treatment depends on what we find in your assessment, and your lifestyle, goals, and level of activity. Furthermore, sometimes we send people off for diagnostic imaging and other times we use don’t because our assessments and clinical expertise have provided a conclusive diagnosis.
I like to break treatment for musculoskeletal injuries down into 2 parts:
First – reducing pain levels so you can return to moving with less or no pain
Second – maintain good function and reduce the risk of the injury recurring
Ways to reduce your pain
Strapping
This is often a first-line treatment that can reduce pain quickly and provide compression. We also use strapping to see if foot orthoses would suit you.
Footwear advice
This advice will differ depending on how your foot moves and what activities you are using your shoes for. Click here to read more about picking the right exercise shoes for you.
Strengthening exercises
Starting off with what your heel can tolerate, we will gradually increase loads on the targeted areas until they replicate or surpass the loads that the areas will undergo in your normal activity.
Stretching & massage
Stretching exercises and massage (by a podiatrist, massage therapist or yourself) can help with temporary relief from the sensation of ‘stiff’ or ‘tight’ muscles. Combined with strengthening exercises, these can help to decrease muscle tightness and increase range of motion.
We often target the plantar fascia, and calf and hamstring muscles.
Manage load & activity
We work with you to modify activity and manage load.
Many injuries are linked to poor load management – this is when your bones and soft tissue may not have enough capacity to take on increased or cumulative loads. In most cases, you should not have to stop exercise completely to resolve your heel pain.
Custom foot
orthotics
Custom foot orthoses offload and control excessive biomechanical forces from the overstressed (and likely painful) area. They can be worn in most shoes as another way to reduce load.
Before prescribing a custom foot orthotic, your podiatrist may also trial in-shoe padding that will have a similar effect in offloading the area of discomfort.
Our ‘hands on’ ways to reduce your pain
Shockwave therapy
Shockwave therapy involves sending high energy acoustic (sound) waves through injured tissue via the skin surface. It increases blood flow to the area and ‘jump starts’ the healing process. It has also been found to stimulate the nerve fibres that are linked to pain receptors, blocking an increase in pain stimuli. Shockwave therapy has the best evidence for persistent and non-resolving heel pain symptoms.
Mobilisation
Foot and ankle mobilisation techniques relieve soft tissue restriction, especially in ankle dorsiflexion. Decreased ankle range of motion has been found to alter biomechanical function and predispose to ankle sprains, calf strains, and plantar heel pain.
Dry needling
Neuromuscular dry needling his involves inserting thin, sterile needles into areas of tightness called myofascial trigger points. By dry needling these sites the muscle can relax and switch off the referring pain. It has been found to be effective for short-term pain relief.
References
Babatunde OO, L. A. (2019). Comparative effectiveness of treatment options for plantar heel pain: a systematic review with network meta-analysis. British Journal of Sports Medicine, 182-194.
Bishop, M. D.-C.-G. (2015). What effect can manual therapy have on a patient’s pain experience? Pain Management, 455–464. doi:10.2217/pmt.15.39
Fleckenstein, J. K. (2018). Neural therapy of an athlete’s chronic plantar fasciitis: a case report and review of the literature. Journal of Medical Case Reports. doi:https://doi.org/10.1186/s13256-018-1770-4
Morrissey D, C. M. (2021). Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British Journal of Sports Medicine. doi:doi: 10.1136/bjsports-2019-101970
Nakamura M, Y. K. (2021). Training and Detraining Effects Following a Static Stretching Program on Medial Gastrocnemius Passive Properties. Frontiers in Physiology. doi:10.3389/fphys.2021.656579
Radford JA, L. K. (2006). Effectiveness of low-Dye taping for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord. doi:10.1186/1471-2474-7-64
Rebekah Young, S. N. (2013). Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis. Journal of Foot and Ankle Research, 46. doi:10.1186/1757-1146-6-46
Tasmin L. Lee, B. L. (2018). Noninvasive, Multimodality Approach to Treating Plantar Fasciitis: A Case Study. Journal of Acupuncture and Meridian Studies, 162-164. doi:https://doi.org/10.1016/j.jams.2018.04.002.
Wrobel JS, F. A. (2015). A randomized controlled trial of custom foot orthoses for the treatment of plantar heel pain. Journal of the American Podiatric Medical Association. doi:10.7547/13-122.1
Book an Appointment at Our Canberra Clinic to Assess Your Heel or Arch Pain
Our podiatrists are here to ensure those in Canberra have access to quality services that can help individuals get the treatment they deserve. Easily book an appointment at our clinic online or give us a call on 02 6198 4818.
