An Article Written by Yen-Chii Wong
Podiatrist – New Step Podiatry
A PODIATRIST'S GUIDE
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?
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?
I have flat feet and I pronate. Is this causing my heel pain?
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.
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?
– 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
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.
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 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.
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.
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.
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