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HEALING HEEL PAIN
Chicken Soup for the Sole:
A Manual Therapy Perspective
By Mark McMahon, DPT, OMT |
Why does it hurt on the bottom of my foot?
The most common diagnosis relating to pain in the underside of the heel (the PLANTAR surface) or the arch is Plantar Fasciitis (see below). However, there are many other possible reasons the heel can hurt, each with its own subtleties.
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Calcaneal bursitis, various kinds of tendinitis, trigger points (or painful knots) in the calf muscles, and even lumbar nerve root irritation (sciatica) can cause or exacerbate heel pain.
And though the resulting heel pains can feel quite similar, these conditions require very different approaches to healing. |
Physical therapists trained in Manual Therapy can quickly identify the most relevant problem(s) and treat each appropriately.
WHAT IS PLANTAR FASCITIS?
The plantar fascia is a thick band of connective tissue running from the underside of the calcaneus (heel bone) to the base of each toe; and anything ending in " -ITIS" indicates inflammation. The attachment of the plantar fascia to the medial (inner) edge of the calcaneus is a very common site for painful inflammation, usually brought on by repetitive ballistic strain such as running or jumping, or by prolonged standing or walking. Classically, the pain is most intense with the first few steps each morning, then tends to ease as the tissues warm up and loosen during the day. Daily repetition of this cycle can lead to debilitating pain, and loss of ability to walk or tolerate exercise.
WHAT DID I DO TO DESERVE THIS?
Maybe nothing, maybe just bad luck: common contributing factors include prior injuries in the leg (fractures, sprains, arthritis, or lumbopelvic/hip dysfunctions), or congenital foot deformities, which may leave you with inefficient joint mechanics or muscle imbalances. These situations can cause excessive loading on the plantar fascia. Again, Manual Therapists can help by sorting out what's what for each individual, treating the stiff areas and retraining muscle imbalances, and providing critical coaching on what kind of exercise to do at which stage of healing.
WHAT TREATMENTS ARE AVAILABLE?
Many people try to get help by changing shoes, using shoe inserts or custom orthotics, using night splints (to keep the plantar fascia stretched out at night so the first steps in the morning aren't so bad). Stretching, self-massage and icing the area also can give some relief. Myriad medical treatments, including ultrasound, lasers, injections and surgery, have been used to treat plantar fasciitis - with mixed results. Chronic cases can linger for months or years.
OK, I'VE TRIED EVERYTHING. WHY DOES IT STILL HURT?
We all have the power to heal our own tissue - in fact, inflammation is the body's own response to tissue damage! With chronic plantar fasciitis, however, our daily loading of the injured tissue is enough to set us back to square one, after a night of rest. To heal fully, we have to understand a few basic principles. Healing occurs in stages:
ACUTE: The first principle of healing is to REST and PROTECT the tissue in the early stages. This means: stop pounding the pavement! Get off the foot if it hurts! Stretch and move the foot VERY gently before getting out of bed in the morning. Aggressive stretching can make it worse during this phase. Certain taping techniques and/or orthotics will also relieve the tissue and allow more normal weightbearing. And, paradoxical as it may seem, wearing a shoe with a small heel will actually decrease the stress on the plantar heel. Ice massage for 3-5 minutes (nature's anti-inflammatory) and NSAIDs (consult your doctor if you're unsure), can help immensely. If these principles are followed diligently, this phase of healing may last only several weeks.
SUBACUTE: When the pain is significantly less sharp and occurs less frequently, then a GRADUAL return to exercise is in order, dosed to provide NO pain, only MILD fatigue, and lots of rest between bouts. THE AMOUNT OF REST WE NEED BETWEEN BOUTS OF EXERCISE INCREASES WITH AGE - one of the major factors in plantar fasciitis (or any tendinitis or overuse injury) in people aged 30-60 is over-exercising. Older tissue needs time to recover; if it doesn't get it, it starts to break down and hurt.
A Manual Therapy approach to heel pain will address your joint mechanics, retrain your muscle imbalances, and get you on the right exercise program to get back to your life PAIN-FREE.
Mark has over 12 years of Physical Therapy experience. Mark earned a Doctor of Physical Therapy degree in 2006, as well as Orthopedic Manual Therapy Certification, through the Ola Grimsby Institute in San Diego. Mark’s experience includes practicing PT in a pain management center, working alongside anesthesiologists and physiatrists.
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Curtis Cramblett
on Outside Magazine |
In March 2009 and over the course of the year Curtis is serving on a panel of fitness experts who will create workouts, explain the science, and consult on issues for Outside Magazine’s four part “Pillars of Fitness Series” addressing the bad habits, myths, and disinformation that permeate much of the wellness community today.
The goal is to deliver essential knowledge to help you get where you want to be in your fitness program.
See May Article: Four Steps to Maximum Speed>
See March Article: Building and maintaining fitness>
