Plantar Heel Pain

Maybe you've heard of the condition known as Plantar Fasciitis. It is the most common foot condition treated by health care providers, affecting as much as 10% of the adult population over a lifetime (1,2). This condition has recently been referred to as Plantar Heel Pain. This terminology is likely a more accurate reflection of the condition- one that typically involves irritation of not only the plantar fascia, but other structures in the sole of the foot. Plantar Heel Pain also indicates the primary location of symptoms- at the heel, along the plantar (ground side) aspect of the foot.

The plantar fascia is a connective tissue on the bottom of the foot that starts at the heel and extends along the foot to the outer three or four toes. This tissue helps to distribute force from the Achilles tendon to the toes during standing, walking, and running.

When tissues along the plantar surface of the foot become irritated, the condition may be initiated by some inflammation and microscopic tears in the tissue. Over time the tissue can become stiffer and thicker because of degenerative changes. Unfortunately, many people who experience these types of symptoms wait as long as a year before seeking professional advice (1).

Possible contributing factors include running, for those with either an increased arch (high arch) or decreased arch (low arch) foot; increased body mass index (BMI); increased time spent standing on hard surfaces, walking, or jumping. Decreased ankle dorsiflexion motion (toes toward the nose) is often a contributing factor also (1,2).

During a thorough examination, a physical therapist will screen movement at all the joints of the lower body to determine any weakness or stiffness from neighboring areas that could be contributing to the problem.

Routine use of some self-stretches for the ankle and foot can be effective (1,1a,3). This includes stretching the calf muscles (pictured below-top) and stretching the small muscles of the foot and toes (pictured below-bottom). Each stretch can be done for 20-30 seconds and repeated 2-3 times. These can be used throughout the day.

Self soft tissue mobilization: In addition, it may be helpful to mobilize the tissues along the bottom of the foot. Try gently rolling the foot over top of a tennis ball or a soup can for one minute at a time.

The suggestions listed above provide gentle, active mobilization to the tissues commonly associated with Plantar Heel Pain. These can offer a safe and effective starting point. However, discontinue if these aggravate your symptoms in any way, as they are no substitute for individualized medical advice.

Whenever soft tissue injury or pain develop, many factors contribute. A visit with a physical therapist (PT) can help determine what specific factors may need to be addressed in your case. This individualized care plan leads to more effective and efficient relief of symptoms- and return to activity.

Evidence supports certain other treatment strategies as being effective in management of Plantar Heel Pain. These include manual (hands-on) techniques to address tension in the calf muscles and decreased joint motion at the ankle (1,1a).

Taping of the foot and/or use of shoe orthotics (shoe inserts) are needed in some cases. A PT is trained to evaluate these needs (1).

There is evidence that highlights the effectiveness of progressive strengthening exercises to help combat the symptoms of Plantar Heel Pain (4). A PT can measure your strength and determine the exercises best suited for you.

If you have been experiencing foot pain, hopefully some increased knowledge about this condition and some of the suggested self-help measures prove successful.

At Synchrony PT we have advanced training and interest in caring for conditions of the foot and ankle. Contact us if you are experiencing ongoing symptoms, or if you have other questions about this type of condition.

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Reference

1. Martin RL, Davenport TE, et al. Heel pain- plantar fasciitis: revision 2014. J Orthop Sports Phys Ther 2014;44(11):A1-A23.

1a. JOSPT Perspectives for Patients 2017: Plantar Fasciitis- Will physical therapy help my foot pain?

2. Buchbinder R. Plantar fasciitis. N Engl J Med 2004; 350:2159-2166.

3. DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am 2003; 85-A(7):1270-7.

4. Rathleff MS, Mølgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Spor 2015; 25(3):e292-e300.