Pain underneath the heel, commonly results from a condition known as plantar fasciitis. It is typically defined as a ‘self limiting’ condition, however can be particularly debilitating to those who suffer from it. In particular clients report pain under the heel when they first put weight on their foot in the morning or go to walk after a period of rest. The pain can be so severe that they are unable to place their heel on the ground. The pain usually resolves after a short period of walking but may recur once they have been on their feet for a period of time, limiting their exercise capacity.
It is often reported that the natural history of plantar fasciitis is for the condition to persist for 6 to 18 months without treatment. Podiatry management can help to facilitate the recovery from this condition and thereby reduce its impact on the individual’s overall health.
Common causes of plantar fasciitis
- Sudden injury or tear of the plantar fascia
- Walking barefoot or in thongs during summer
- Occupations involving long periods of standing/walking
- Sudden increases in load on the foot, such as returning to sport after a long break or changes in training frequency and intensity
- Changes in footwear or worn-out footwear
- Poor foot mechanics such as flat or high arched feet
When should I see a podiatrist?
At Tripod Podiatry we would recommend that you consult a podiatrist if you have pain underneath your heel which has failed to improve from 4-6 week period of self management, including the following:
- Rest from aggravating activities
- Icing the heel after activity
- Stretching/Massaging the arch and calf muscles
Further we would recommend more immediate consultation if:
- Your heel pain is worsening
- You are unable to perform regular daily activity due to your heel pain
- You want to accelerate the recovery process, early management can improve your outcome
What can a podiatrist do?
- Obtain a thorough history of the events leading up to the onset, often the contributing factors that triggered the onset can be identified and hence remedied.
- Conduct a thorough physical examination to confirm the diagnosis of plantar fasciitis.
- Evaluate any intrinsic and extrinsic factors which may have contributed to the condition.
- Intrinsic factors include poor foot mechanics, poor physical condition eg increased weight, training load, walking and running technique issues.
- Extrinsic factors include incorrect/worn out footwear, training terrain.
- Formulate a management plan for your specific presentation, this may include:
- Short term management
- Goal is to provide relief of pain in both acute and chronic cases.
- Taping to unload the plantar fascia.
- Manual therapy to the foot and ankle, including mobilisation of stiff joints and release of tight muscles in the foot and lower leg.
- More specific self management strategies targeted to your individual condition.
- Advice on appropriate footwear to assist in your recovery.
- Longer term management
- For more persistent/chronic cases, or in those with higher risks of recurrence.
- Exercises to retrain and strengthen specific foot muscles.
- Orthotic Therapy to correct poor foot mechanics and unload the plantar fascia.
- Additional options may include night splinting and Shockwave therapy
- Referral for more invasive medical management such as injections and surgery is avoided and treated as a last resort option.
- Short term management