Don’t Let Plantar Fasciitis Stop You!
It’s the first few steps in a morning, it’s standing up from the sofa, it’s while you’re running…and the thought is always the same - when will my heel pain get better? This is the eternal question wondered by anyone with heel pain that wants it to go away!
The road or path to recovery starts by stop wondering - as we have all the answers and we are going to lay it out in a few simple steps. We’ll explain the condition so that you understand what it is, what we can do to help you and how you can also help yourself.
Plantar fasciitis has been a problem for a long time and unfortunately, in the past, it hasn't been as well managed as it could have been by health professionals. This was simply because the research on the topic wasn't as advanced as it is currently.
Now we have the latest research, the latest technology, and the experience to help manage this problem quickly and more effectively than ever before. Take a look below as we educate and guide you through all the knowledge and the options available to you, to get rid of your pain and get you moving again.
Why is my heel sore?
Often when thinking of a reason for the heel becoming sore, patients tell me they are unsure and that they don't think there is a particular reason that’s caused it. There is typically always a reason why your plantar fasciitis has occurred – your body will always try to regulate itself and keep you mostly pain-free. If you have heel pain, it is typically a sign you have done something to cause it.
Typical causes can be:
- Changes in footwear
- Changes in activity levels
- Impact to the heel
- Biomechanical/postural issues
If you have recently changed to new footwear which may be quite hard and unsupportive, let’s say for example, safety shoes at work – this can aggravate your heels, especially if you work on your feet for long periods. Changes in activity levels are one of the biggest reasons, this is because your heel and its issues are used to a certain amount of walking, standing and running. If we suddenly increase the amount, then it can place too much demand on the heel and cause it to become sore. Standing on a blunt object with the heel can also cause local injury to soft tissue and this can also trigger plantar fascia issues. Other less prominent causes can be if there are structural and biomechanical issues with the feet that cause excess pressure on the plantar fascia tissue.
Take a look at the diagram below as we look at the structures involved.
The plantar fascia connects from the heel and runs towards the toes. When it has too much demand placed on it, it develops micro tears which causes pain, inflammation, and changes to your normal function. The fascia helps to contract the sole of your foot to move your toes – especially the big toe. A lot of your rehab will focus on movements of the whole foot and not just the heel.
What can be done?
As we touched upon at the start, changes in technology and research mean that treatment of heel pain is now extremely effective.
At MSK Sports Injury Clinic in Newcastle, we have a state of the art shockwave machine which is effective in the management of plantar fasciitis (check out our shockwave blog). This treatment involves a shockwave current (which are high energy sound waves) being placed through the heel to help stimulate healing of the injured tissue, which can sometimes be stubborn and need encouragement to heal!
Typically, treatment for this will take a few sessions to have the best impact and reduce your symptom level. Your shockwave treatment will be part of a course of therapy including a rehab plan with education and self-treatment measures which you can perform at home.
What can I do?
Injuries always improve more quickly when we provide them with consistent input and the same is true for heel pain. Following treatment in the clinic, there are some important things you should be doing to help your plantar fascia start to heal.
Self-treatments such as a frozen water bottle or hockey ball to rub over the painful areas are great ways to reduce your pain level, stimulate circulation and reduce the tension experienced in the heel. They will not help to fix the problem but they do help with pain levels.
Exercises and rehab are a must – the fascia is painful and with that comes weakness. For you to return to normal and perform as you were pre-injury either at home, at work or in your sport – you must strengthen your foot and heel to ensure you are balanced for standing, walking, running, and jumping.
Typically, your doctor may provide exercises for you to perform if they diagnose you in their clinic, but often they aren’t the latest exercises which have the best effect. Your rehabilitation has to include strength and loading exercises - this is essential as placing weight through an injured tendon/fascia helps to stimulate blood flow to the tissues and encourages further healing.
Some of my favourite exercises which my clients have had success with include the following:
- Big Toe Extension Stretching – this can help to loosen the tightness and reduce pain in the foot and heel. The stretch must be performed for a minimum of 20 seconds and acts as a way to load the toe up with some weight.
- Spikey Ball Plantar Massage – Sit down on a chair, and place a hard ball under the sole of your foot. Roll the ball up and down your foot, between your heel and your toes. Do not massage the heel area, but keep to the soft plantar fascia on the sole of the foot
- Towel Picking with Toes – have a tissue or a towel on the floor and try to flex the toes to pick up the material. This ensures you are working the muscles on the bottom of the feet.
- Heel Drop Calf - Stand with your toes on the edge of a step or a box. Hold onto something stable for support if required. Drop your heels downwards. You should feel a stretch just below the back of your knee, in the calf (this part of the calf is known as the gastrocnemius).
- Calf raises – these can be done from the floor or over the edge of a step and have to be performed slowly with long holds. Aim for a tempo of 3 seconds up, 3 seconds hold and 3 seconds down.
- Heel Drop Soleous – Stand with your toes on the edge of a step or a box. Hold onto something stable for support if required. Drop your heels downwards. You should feel a stretch just below the back of your knee, in the calf (this part of the calf is known as the gastrocnemius).
- Plantar Fascia Stretch - Sit comfortably, and place your foot on your opposite knee. Grasp your toes and pull them backwards to create a stretch to the sole of your foot. Hold the stretch for the required length of time.
- Passive Plantar Flexion - Sit with one leg over your opposite knee. With your hand gently pull the ankle towards you, and then relax. You can use this as a mobilisation to your ankle, to improve mobility, but also to create a stretch along your shin and the top of your ankle.
- Tip-Toe Walking – this is a bit more advanced for when your pain starts to settle it gives a chance to test the foot, heel and ankles resilience by placing bodyweight through the healing area – this really improves strength and functionality.
Big Toe Extension
Spikey Ball Plantar Fascia Massage Sitting
Towel Picking with Toes
Heel Drop Calf
Heel Drop Soleus
Plantar Fascia Stretch
Passive Plantar Flexion
Tip Toe Walking
To see what our full Rehab My Patient plan looks like for Plantar Fasciitis, click on the PDF below. All patients at MSK Sports Injury Clinic receive a detailed plan like this one using our clinical software Rehab My Patient. This software is great, simple to use and great for tracking the progress of your client. You can see in this PDF the great detail Rehab My Patient goes into with their images, videos, description and progress diary to make it as easy as possible for the patient.
I hope this guide helps you to understand why we can all be susceptible to heel pain, but more importantly, the ways we can help to stop the pain. Heel pain is such a common problem through all areas of the population - unfortunately, it does not discriminate and it can happen to absolutely anyone!
Luckily we have you sorted – if you aren’t sure how to manage your heel pain, call or email the clinic and we can talk you through exactly what you need to do. Fortunately for you, we’ve helped a lot of people.