When someone is suffering from heel pain, the most common reason is due to plantar fasciitis. It is also the third most common complaint in runners, behind patellofemoral disorders and iliotibial band syndrome. There are plenty of myths about plantar fasciitis, as well as a whole host of substandard information on the Internet waiting for those with heel pain to stumble upon. The plantar fascia is located on the bottom of the foot and attaches near the toes and on the heel bone. Plantar fasciitis is a condition where the plantar fascia becomes aggravated from repetitive overloading. In some cases, it progresses into a degenerative change called plantar fasciosis. The most common symptom is pain near the heel of the foot that is experienced on the first step of the morning and whenever they have been lying or sitting down at length. In some cases, prolonged standing can aggravate the foot, so it may also be painful in the evening.
The thing is that when it comes to treating heel pain, you need to make sure that you actually have plantar fasciitis. People who have been suffering for more than a few weeks should be seen by a qualified healthcare practitioner. If you have done what you can on your own and it is still on fire, you need to get a proper examination. There can be a number of other things affecting the foot that are not plantar fasciitis. It is a simple diagnosis, but it often gets screwed up by both lay people and healthcare professionals. It is quite common for me to find specific problems during an examination that are even missed by podiatrists. And be wary of any healthcare provider that suggests surgery without exhausting all conservative measures available beforehand.
Heel pain has been linked with muscle atrophy of the foot muscles and excess loads being placed on the plantar fascia. Biomechanical problems in the ankle, knee or hip can also contribute. In runners, faster running paces and mileage have a direct impact on the risk for plantar fasciitis and the recovery from it. Because of the complexity of the biomechanics, an individual runner may not be able to know whether the problem is related to speed, mileage or an unidentified biomechanical problem.
Treatment of Plantar Fasciitis
Plantar fasciitis is notoriously difficult to treat, but there are multiple treatment options. Treatment options include stretching, ice, modifying foot ergonomics, off-the-shelf arch supports, manual therapy, therapeutic exercises, casting, over-the-counter nonsteroidal anti-inflammatory medications, custom foot orthotics, corticosteroid injections and a surgery that “releases” the plantar fascia. Some of these treatments work very well, but some treatments like surgery have a long recovery time and many do not really resolve the problem. Several treatments have the ability to cover up pain for a short period of time but do nothing in the long-term to reduce suffering.
Ultimately, I have found that a combination of five steps is extremely successful in resolving plantar fasciitis. This resolution can happen for patients that have suffered for a few months to patients who been limping in the morning for years.
- Squelch the fire: Using ice, possible activity modification (if tolerated by the runner), nutrition and possibly custom foot orthotics.
- Chiropractic Adjustments to the foot and ankle, if needed to improve motion of the foot and ankle.
- Kinesio Taping: applying tape helps control the fire and provide support to the arch, but it needs a trained person to apply it properly.
- Graston Technique: evidence-based treatment that quickly facilitates healing, improves ankle motion and improves ability of tissue to take load using special stainless-steel instruments.
- Rehabilitation of foot and ankle
Trying arch supports can help squelch the fire. These devices can help to control the motion of the foot and is one of the ways that heel pain is treated. Pre-made arch supports, bought at your favorite local running shoe store, are a good option to start with to see if you can put out the fire but sometimes people need to get custom-made foot orthotics. These foot orthotics can be obtained from podiatrists and knowledgeable chiropractors as well as some physical therapists. Not all custom-made foot orthotics are casted or even made in the same way and the quality varies considerably. If you can bend the orthotic in half with your fingers, is not providing the correct support. Orthotics should be thought of like a crutch in that you should only use it for the period of time that you need it and eventually you should try to earn your way out of relying on that insert. If you are constantly bracing the foot by using an orthotic, the foot does not build the resiliency needed to be without the orthotic.
Mileage and speed fans the fire as well. For many runners that suffer from heel pain, their feet do not bother them during the run. They have the tendency to feel the heel pain after they’ve gone on a run and inflamed their plantar fascia. Or maybe they just feel worse the next day. One of the things that some podiatrists use will be either casting the foot or having the person wear an ankle foot orthotic (AFO) device. This is an extreme example of stopping the irritation by halting the person from running. It can be effective at stopping some of the pain, but the underlying issue is not corrected and as soon as the person begins regularly running again, the pain returns. But it demonstrates the fact that running volume and speed do play a role in managing plantar fasciitis. Some runners would benefit by taking some time off running, but it is not necessary if the patient is treated correctly. Besides I know that if you tell a runner to stop running, they typically just stop listening to you and they go for a run anyway. What the runner can do is consult their running coach on ways to modify their training program to possibly reduce mileage or reduce pace in some areas.
Proper rehabilitation of the foot, ankle and even the toes is extremely important. Exercises improve the ability of the tissue to take load and prevents the problem from recurring again and again. It’s more than just teaching a simple runner’s stretch and doing calf raises. There are certain types of exercises that are rarely taught to people who suffer from foot problems, but they should be learning them. Specific rehabilitation exercises will help them heal and strengthen the foot, as well as prevent the problem from coming back.
There are multiple different types of treatments for heel pain and conservative care should be your first option. The steps that I have laid out have allowed me to help people suffering from plantar fasciitis recover, even while they are in the process of training for a marathon. Exhaust possible treatments because there are things that can help you get better and try to avoid surgery as much as you can because once you cut, you can’t take it back.
For anybody who wants more information about heel pain, its treatment options and my opinion of night splints, please visit my website at https://BestToledoChiropractor.com/Heel-Pain.
Article Featured in Toledo Roadrunners Club Footprints – Volume 45, Issue 3 (March 2019)
MORE INFORMATION ABOUT DR. ROYER
Dr. Bryan D. Royer has been practicing chiropractic medicine in the Toledo area since 2005. He has a specialty in Sports Medicine and is a Certified Chiropractic Sports Physician® (CCSP®). Dr. Royer is certified as a Graston Technique® Specialist (GTS), a Certified Kinesio Taping Practitioner™ (CKTP™) and a Corrective Exercise Specialist (CES). He is also a Board-Certified Chiropractic Neurologist and he has been voted “Best in Toledo” by readers of the Toledo City Paper five times.