Heel pain is a common complaint of the foot. Causes of chronic heel pain include:
- Plantar fasicitis/tendinopathy
- Heel bursitis
- Tarsal tunnel syndrome
- Stress fracture
- Severs disease
This article will focus on the most common cause of chronic heel pain, plantar fascitis or plantar tendinopathy. Symptoms can start as mild pain or stiffness and progress to a sharp stabbing pain underneath the foot toward the heel. Pain is often worst in the morning, after standing for prolonged periods or upon standing after being seated for a period of time. It is more common in middle-aged and younger active people.
There are a number of regularly used treatment options available for sufferers of chronic heel pain which include:
- Foot stretches
- Medication (NSAIDS)
- Corticosteroid injection
- Sports taping
- Shockwave therapy
- Orthotic therapy
- Night splints
Sport & Spine approach:
The Sport & Spine approach to diagnosis and treatment of plantar fascitis/tendinopathy differs to other commonly used approaches. Diagnosis is focused on identification of areas of sticky scar tissue in the foot and lower limb that prevent normal movement between tissue layers. Each time there is a spike of sharp pain in the foot there is microtearing that occurs, and sticky scar tissue is laid down during the early phases of inflammation to heal the area of torn tissue.
This is an essential phase of tissue healing, however one side effect of this scar tissue growth is that tissue layers are no longer able to glide between one another, causing this area to become a point of weakness and prone to further tearing and injury (see: soft tissue mobilisation).
A functional movement evaluation of the lower limb (including the foot) and lumbopelvis helps to identify structures above that contribute to excessive loads going through the foot.
Sport & Spine treatment:
The Sport & Spine approach to treatment of plantar fascitis/tendinopathy is focused on manual or instrument assisted breakdown of sticky scar tissue in the foot, and correction of poor movement patterns identified in the functional movement evaluation. This is done by utilising a combination of chiropractic adjustment techniques and soft tissue mobilisation.
Another very important part of the Sport & Spine treatment regime is the DiGiovanni plantar fascia stretching exercise. In 2006, DiGiovanni et al. published a research paper in the Journal of Bone and Joint Surgery entitled: Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up with excellent results.
To perform the stretch the patient sits with one leg crossed over the other, stretching the arch of the foot by taking one hand and pulling the toes back toward the shin for a count of 10. The stretch must be repeated 10 times, at least three times a day, including before taking the first step in the morning and before standing after sitting for 30 mins or more.
If you’ve tried a bunch of things for your heel pain and nothing has worked, give us a call, or book online and we’ll see if we can help you.