Plantar Heel Pain
What are some common symptoms of heel pain?
Do you ever experience this annoying pain at your heel that never seems to go away? Is there pain in the heel especially with your first step in the morning upon getting out of bed? Or perhaps feeling heel pain when standing up after sitting for a long period of time?
Urgghh!! What is that nagging pain at your heel?! It is most likely plantar heel pain!
What causes plantar heel pain?
The heel is the largest bone in the foot, and is often prone to injury due to overuse. Heel pain may range from mild to disabling, depending on the severity of the condition. The pain may be caused by inflammation, trauma, or a systemic disease such as rheumatoid arthritis.
We explain 2 common conditions that often lead to heel pain – plantar fasciopathy and Achilles tendinopathy.
1. Plantar fasciopathy
Plantar fasciopathy refers to an inflammation of the plantar fascia, which is a thick fibrous band that connects your heel to the front of your foot.
The plantar fascia is a thick elastic sheet that extends across the sole of our foot. This thick elastic sheet plays an important role in stabilising and supporting the arch of our foot, as well as dissipating impact/ force as we land while running/walking.
When it is inflamed or torn, putting pressure on the foot may result in sharp pain. Plantar heel pain or “plantar fasciopathy” usually develops when the plantar fascia tissues are overloaded beyond its capacity. What does that mean? It can be from spikes of sudden increment in weight-bearing activities/ training at large volumes (i.e long hikes, runs), or even those with occupations requiring long hours of walking or standing.
Symptoms of plantar fasciopathy
Plantar fasciitis causes pain in the bottom of the heel, which extends into the arch of the foot. The intensity of pain may vary; the pain may be sharp or may feel like widespread soreness in the area surrounding the heel and the arch. A common symptom of plantar fasciopathy is a stabbing pain that occurs when you take your first steps in the morning. The pain usually decreases as the day progresses with use of the foot, but may return after long periods of standing or when you stand up from a sitting posture. This is usually called the warm-up effect of the fascia.
Who is at risk of plantar fasciopathy?
While the cause of this condition is unclear, there are factors that can increase your risk of developing plantar fasciopathy:
- Age – the condition is more common among those aged 40 – 60
- Flat feet, high arches, or tight calf muscles
- Obesity – extra pressure on your feet due to significant body weight
- Medical conditions such as arthritis
- Exercises that repeatedly impacts the plantar fascia such as running
- Standing for extended periods
- Wearing high-heeled shoes
What are some treatment for plantar fasciopathy?
There are some possible treatment options available for plantar heel pain for example corticosteroid injection, surgery or non-surgical management like Physiotherapy or Podiatry.
Doctors may suggest corticosteroid injection especially during the acute phase of heel pain. Nonetheless, the effectiveness of this treatment may depend on individuals.
2. Achilles Tendinopathy
The Achilles tendon is the largest and strongest tendon (tissue connecting a muscle to a bone) in the body, connecting the calf muscles to the heel bone. The Achilles tendon helps you in walking, running and jumping.
Achilles tendinopathy refers to the inflammation of the Achilles tendon. It can be caused by any activity which causes repetitive stress to the tendon, such as playing basketball or running. A sudden increase in the amount or intensity of exercise activity may also lead to Achilles tendinopathy.
Symptoms of Achilles tendinopathy
A common sign of Achilles tendinopathy includes pain in the back of your heel that worsens with activity. You may also experience severe pain the day after exercising. Other symptoms include swelling along the tendon, and tenderness or stiffness, which may improve with mild activity. However, it is also possible that you may not have any signs or symptoms.
Read more here to find out more about the 2 main kinds of achilles tendinopathy.
Who is at risk of Achilles tendinopathy?
Achilles tendinopathy is more common in men than in women. Other risk factors for Achilles tendinopathy include old age, a naturally flat arch in the foot, obesity, and tight calf muscles. Medical conditions such as psoriasis or high blood pressure and use of certain medications such as antibiotics may also increase your risk of Achilles tendinopathy.
How can Physiotherapy help with plantar heel pain?
An assessment of the foot and surrounding structures will be carried out as well as looking at the lower limb to ensure that there are no significant contributing factors to the pain. The hip may sometimes be implicated as a contributing factor in plantar heel pain. The Physiotherapist will ensure that muscles around the area are kept strong and flexible as well as working closely with our in-house Podiatrist to ensure that the proper footwear is being used to ease pain.
Treatment may include but is not limited to:
- Advise and education pertaining to your condition
- Soft tissue therapy
- Movement with mobilisation
- Heat therapy
- Dry needling
- Shockwave therapy
- Taping to support foot arch
- Movement training
- Returning to sport training
- Exercises for heel pain seeks to address any deficits in your ankle or hip strength which could contirbute to the onset of your heel pain