Heel pain is a common condition. Pain in the arch of the foot, where it meets the bottom of the heel, is most commonly diagnosed as Plantar Fasciitis.
Typically the pain is worse with the first few steps in the morning or after prolonged sitting. The pain maybe worsened with running or prolonged walking. The pain can be, but is not always, reduced with light activity. The heel pain typically comes on gradually and progressively. On examination there is local tenderness on the bottom of the heel bone towards the arch. The tenderness may extend into the arch itself.
Common causes of heel pain can be due to the bony structure and/ or alignment of the foot, ankle, lower limb and spine. A flattened arch can put excessive strain on the plantar fasciitis. Commonly, there are muscle imbalances around the ankle and lower limb. Work and/or training factors should be considered such as prolonged standing, a sudden increase in activity, etc. Commonly there is a lack of mobility in the joints of the ankle and muscle tightness around the ankle.
Manual Physiotherapy treatment of plantar fasciitis is multifactorial:
- Improve the joint mechanics and improve muscular flexibility around the foot and ankle. This is done through hands-on joint and soft tissue mobilization/manipulation.
- Check for other underlying biomechanical faults in the leg and spine. Check for altered mobility of the nerves and soft tissue in the leg and spine.
- Unload the plantar fasciitis with sports tape or a temporary orthotic. Typically the relief felt is significant with a reduction of pain almost immediately. Taping the plantar fasciitis is also helpful in determining if a referral for orthotics is necessary. With correct taping a 50% improvement in pain with taping is expected before recommending custom orthotics.
- Assist the healing through use of physiotherapeutic modalities like ice, electrical stimulation and ultrasound.
- Provide an exercise program to improve mobility and strength around the foot and ankle. An exercise program would also address any other muscle imbalances around the spine or leg.
- Educate to reduce strain on the plantar fasciitis through change in footwear, work habits, as well as training factors.
- Another treatment option with more ‘stubborn’ cases is IMS dry needling of the foot, calf and spine muscles.
If the plantar fascia does not respond to physiotherapy treatment, a night splint, which keeps the foot held at a 90° angle all night can be used. Another option is to see your family doctor to discuss the use of medication or a local cortisone injection.