8 Tips for Managing Heel Pain - Advice from a Physiotherapist
Plantar fasciitis is one of the most common causes of foot pain in adults. More than one in ten of us will experience it in our lifetime. It is characterized by pain on the bottom of the foot, most commonly on the inside and bottom of the heel. Although it can affect people of all ages, it is most common in people aged 40-60. However, certain populations, especially runners, may experience it at a younger age.
Plantar fasciitis can be extremely painful and debilitating, limiting your ability to walk, run or stand. Luckily, there are a number of evidence-based treatments that can support your recovery. A physiotherapist can support your recovery from plantar fasciitis through treatments including education, exercise, manual therapy, taping, and shockwave therapy. Depending on your needs, it may be beneficial to involve additional practitioners to assist with orthotics and splinting.
How Do I Know If I Have Plantar Fasciitis?
One of the hallmark signs of plantar fasciitis is pain in the heel during the first few steps in the morning. Overnight the plantar fascia tightens up, and when you take your first step the fascia stretches out. This stretching of the fascia can be extremely painful.
Plantar Fasciitis tends to calm down after the first few minutes on your feet in the morning. Although it tends to improve after the initial pain in the morning, it tends to get worse with extended periods of load (ex. standing, walking, running).
Why Does Plantar Fasciitis occur?
Although the exact causes of plantar fasciitis are not well understood, the most common causes are likely related to repetitive stress and overuse of the plantar fascia. Often this is in combination with other risk factors such as obesity, poor foot biomechanics (such as flat feet), poor low back biomechanics, or a sedentary lifestyle.
Overuse of the plantar fascia is often related to training errors, or to changes in your normal routine. For example; increasing the amount of walking or running you are doing too quickly (ex. Changing intensity, distance, hill work), starting a new physical activity routine, or changes in footwear (ex. Wearing different shoes at work, during the day, or during your exercise routines). The change in the amount of load or how the loading occurs is a key factor in the development of plantar fasciitis.
How Do I Treat Plantar Fasciitis?
There are a number of evidence-based treatments that are a part of the treatment of plantar fasciitis. A physiotherapist is often the key person who will walk you through your treatment options and make sure you have a plan that is specific to your needs, your body, and your goals.
1. Get Help Early
As someone who has treated a lot of people with plantar fasciitis, there is one big thing I can tell you. The longer you have pain, the longer it takes to get out of pain. If you recognize the signs early and get help early, the likelihood of you getting back to what you love quickly is much higher. The sooner you can identify and fix the training error that has occurred, the better for your recovery.
2. Figure Out Your Triggers For Heel Pain
The first step to recovery is figuring out why your plantar fasciitis occurred and fixing any training errors. Did you increase your running too much? Did you change your shoes? Did you increase your amount of hill training? Did you start a new exercise routine? Have you been wearing flip-flops because it's summer? Your physical therapist will help you figure out what happened. Correcting the cause is step one on your road to recovery.
In addition to correcting the acute cause of your plantar fasciitis, you want to make sure there are no other significant contributing factors. These could include poor biomechanics, or issues with your knees or hips. Without a complete picture of your body, it’s difficult to properly treat your condition.
3. Strengthen Your Arches
Rest is very important for reducing pain in the initial phase of recovery, but it’s only the first step. After the initial pain has subsided, it’s time to work on strengthening your arches. If you were to go back to the activity that caused the problem without first working on your arches, chances are your pain will return. Strengthening your arches will help keep the pain from returning, and keep you doing what you love!
We need to focus on strengthening both the intrinsic and extrinsic muscles of the foot. Intrinsic muscles are small muscles in the bottom of our foot that support our arch and plantar fascia. These muscles start and end within the foot. Extrinsic muscles are muscles that originate outside of the foot, but end in the foot. Good examples of extrinsic muscles are your calf muscles. Both intrinsic and extrinsic muscles support your arch. Stronger muscles can support more load, which means your fascia doesn’t have to. If your fascia isn’t overworked, it won’t hurt!
But what about flat feet? Recent research has shown that arch-specific strengthening exercises can improve the shape of your arch if performed for a minimum of five to eight weeks (Huang et al., 2022; Hara et al. 2022). These exercises are called short foot exercises. See our Instagram video for how to perform these arch-specific strengthening exercises for heel pain.
4. Stretch Your Plantar Fascia
Stretching your plantar fascia has been shown to be one of the key ways to reduce plantar fasciitis-related pain. Research shows that plantar fascia specific stretches reduce pain significantly more than traditional calf stretches. (Siriphorn, 2020).
The plantar fascia specific stretch that is most recommended by researchers is as follows: While sitting, cross one leg across the other, pull your big toe as far back as you comfortably can, letting your ankle bend at the same time. Hold for 30 seconds on each side. Repeat three times per day.
Plantar fasciitis specific stretch (Celik, 2016)
5. Warm Up Your Arches In The Morning to Help Your Heel Pain
Performing some basic foot movements before getting out of bed can significantly reduce your pain in the morning. Flexing and extending your foot, making circles with your ankle and rolling a ball on your arch can all help to loosen the fascia in your foot. I recommend doing any or all of these movements for one to two minutes before standing up in the morning.
If you are performing all of these movements and they are not helping, you may want to talk to your local physiotherapist to see if night splints are appropriate for you.
6. Support Your Arch with Tape or Orthotics
Taping the arch and the heel can provide pain relief for people with plantar fasciitis. It does this by placing your foot in a better position and supporting the arch.
Another way to put your foot in the correct position and support the arch is through the use of orthotics. These can either be off the shelf, or custom-made.
It is important to note that although these treatments can provide pain relief, they are not a permanent solution. To fully recover from plantar fasciitis, you need to address the root of the issue by following the advice given above. If you were to remove the orthotic or tape, without first addressing the cause and strengthening your arch, your pain will likely return.
7. Access Manual Therapy
Manual therapy such as massage and mobilization of the joints in the ankle and foot has been found to improve function for people with plantar fasciitis (Fraser, 2020). Therefore, manual therapy is often a key part of treatment, but it is still just one part of recovery. Manual therapy by itself, can improve your mobility and reduce pain, but without a full course of treatment, including stretching and strengthening, your pain will likely return.
8. Access Shockwave Therapy
Shockwave therapy has also been proven to be an effective component in treating plantar fasciitis. Shockwave is a type of therapy that aids the healing process by increasing blood flow and bringing neurochemicals related to healing to the area (Rhim, 2021). This treatment is especially recommended for patients who have had pain for an extended period of time and have not responded to other treatments (Morrissey, 2021).
Conclusion
Although plantar fasciitis can be debilitating, there is a lot of evidence that physiotherapy is an effective treatment option. Treatment includes a combination of education, adjusting training errors, strengthening, stretching, taping/orthotics, manual therapy and may or may not include the addition of adjunct therapies such as shockwave therapy.
Physiotherapy has been shown to be effective at managing pain and improving function in individuals with plantar heel pain. If you are experiencing pain in the heel or bottom of your foot, seek help from a physiotherapist early. Please call us, email us, or book an appointment online if you need support in your recovery.
