It feels like walking on broken glass – Plantar heel pain and how to fix It.

February 3, 2020

So the winter weather has taken its toll. You need to get some time in the sun, so you book a holiday to Tenerife! You’ve bought the new clothes, complete with a pair of Havanas. You fly there, and everything is going great! A few days into the trip, you wake up with a severe pain in the heel, which hurts to even walk. Suddenly it feels like your holiday is ruined.

An estimated 1 in 10 people will experience heel pain in their lifetime, so its quite likely that you or someone you know would have experienced this before. This month’s blog will be talking about heel pain and hopes to give you some practical tips to both manage and prevent this!

What is plantar heel pain? 

Plantar heel pain simply means heel pain in the sole of the foot (plantar meaning sole of the foot). The causes of this can be mechanical, neurological, arthritic, traumatic or other systemic conditions although most of the causes are mechanical in nature.

Plantar heel pain is a non-specific diagnosis, which means that there could be multiple foot structures responsible for this pain. The most common structure that is the source of plantar heel pain is the plantar fascia, and you will mostly likely have heard of the diagnosis plantar fasciitis. 

Other structures such as the foot muscles, tendons, heel fat pad, nerves and bones can all be a potential source of pain. However, the anatomy of this region can be rather complicated, and it is often more important and practical to identify the causes instead. 

What causes this?

The common theme in the stories of people with plantar heel pain tends to be a sudden change in overall load going through the foot. This can be due to change in footwear, sudden increases in walking/running volume (i.e. training for runs, starting new exercise regimes, holidays), injuries that limits weightbearing for a prolonged period (i.e. lower limb fractures). These are considered extrinsic causes of plantar heel pain.

Other causes will include altered foot mechanics, decreased ankle mobility, increased bodyweight, decreased ankle and foot muscle performance. These are considered intrinsic causes of plantar heel pain.

The earlier story is the perfect example of this. New footwear and with significantly more walking than what you might be used to, coupled with tired foot and ankle muscles from all the walking. Combined, this can significantly increase the loads going through the heel, much more than what it is used to. This then overloads and irritates the structures around the heel.

How do I know if I have this?

Plantar heel pain tends to have a very mechanical presentation. This means that the symptoms are very consistent in what makes it worse and better.

Common symptoms of plantar heel pain

  • Pain mostly localized on the heel
  • Pain aggravated on weight bearing, either in morning or after periods of rest
  • Pain improve with activity, but returns as time on feet increases
  • Pain that worsens with less-supportive footwear (i.e. flip-flops) or barefoot
  • Sometimes, numbness/tingling around the heel region

How to resolve this/prevent this

You will be glad to hear that heel pain is a largely self-limiting condition that goes away with rest and activity modifications. However, this condition can be stubborn as well and takes longer than we would like to resolve. Here are some things you can try to help things along.

Identify the pattern;

Find out what makes the pain worse! This is usually the extrinsic cause of heel pain, such as excessive walking and/or standing. Once identified, a period of relative rest from this activity is indicated, meaning not little nor too much. This is because some amount of load is still required to stimulate the structures around the heel to adapt. Often, the pain gets better with some activity such as standing or walking as well, sort of a warm-up effect. 

*For activities that make it worse, it is often helpful to take note of how long you are able tolerate this and stop before you reach that point  (i.e. if walking for 30 minutes is too painful, try 15 minutes instead).

Offload;

You can do this by finding a comfortable pair of shoes that is well-cushioned. Shoes that have a heel drop (i.e. heel slightly higher than the toes) tends to work quite well. An alternative will be heel cups to raise the heel slightly. You can find this in any high street pharmacy.

Exercise;

Here are some exercises you can try from our recent exercise series to help target the intrinsic causes of plantar heel pain!

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Heel pain series ⁣ ⁣ Plantar fascia heel pain can be a very severe disabling injury 😞 the pain itself is usually felt on the base of the heel 🦶🏻⁣ ⁣ It tends to be most painful in the morning especially with the first few steps and eases off as you get moving 🚶‍♀️ ⁣ ⁣ The pain generally starts coming back towards the end of the day, or if you have been sitting/lying and then get up to walk again. It will likely to be worse if you have been up on your feet a lot throughout the day 🏃🏿‍♂️ ⁣ ⁣ The plantar fascia primarily function as a shock absorber (similar to a spring) and it does a really good job at that. Sometimes, it is asked to do too much and when it’s not given enough time to adapt, the tissue can sometimes become painful 😣 ⁣ ⁣ This exercise technique can help to give you some relief, especially if the foot has been stressed significantly. ⁣ ⁣ As mentioned in the video, you can use a tennis ball, golf ball, edges of stairs, rolling pin… you get the idea! ⁣ ⁣ Start off sitting down as it is easier to adjust the amount of pressure through the foot. Find the sore bits (usually there is more than one) and hold for 20-30seconds on each of them. ⁣ ⁣ Some mild pain/discomfort is expected, so apply pressure to the level you can tolerate.⁣ ⁣ This exercise should not make the symptoms worse. If it does then stop ✋🏻 and drop us a DM for help 🆘⁣ ⁣ ➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖⁣⁣⁣ 📲 Book by phone on 01324 227 370⠀⁣⁣⁣ 🌏 Book online at espphysio.com⠀⁣⁣⁣ ⁣⁣⁣ Proud to support 🌐 ⁣⁣⁣ @stevenraymma ⁣⁣⁣ @dannyhenrymma ⁣⁣⁣ @tomstoltman⁣⁣⁣ @luke.stoltman⁣ @the_problem155⁣ ⁣⁣⁣ Affiliates 🌐 ⁣⁣⁣ @pulseroll – £10 off using code ESPPhysio10 ⁣⁣⁣ @stirlingcounty⁣ ➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖⁣⁣⁣ ⁣⁣⁣ #physiotherapy #physio #physioglasgow #physiostirling #physioedinburgh #physiofalkirk #espphysio #stirlingcountyrugbyfootballclub #footpain #plantarfascia #plantarfasciitis #heelpain #tightcalfs #calfstrain #tibialisposteriortendinopathy #physioadvice #mobility #exercises #flexibility #mobility #romwod #strength #espphysio #physioblog⁣

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HEEL PAIN SERIES⁣ ⁣ Following up from the previous video, here is a stretch for the calf and sole of the foot 🥳⁣ ⁣ The plantar fascia and surrounding muscles tend to tighten up. You need it be relatively flexible in order to perform its function as a shock absorber. ⁣ ⁣ The plantar fascia and tie flexor muscles are stretched maximally when the big toe and ankle is dorsiflexed (i.e. pulled upwards) ⬆️⁣ ⁣ Perform this stretch on a step, wall, or skirting board. The stretch should be felt right in the sole of the foot and the calf, depending on which zone is stiffer for you 👍🏻⁣ ⁣ Hold this stretch for 20-30 sec, repeating up to 5 times, keeping the intensity to just slightly past uncomfortable. Perform daily or as and when possible.⁣ ⁣ This exercise should not make the symptoms worse. If it does then stop ✋🏻 and drop us a DM for help 🆘⁣ ⁣ ➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖⁣⁣⁣ 📲 Book by phone on 01324 227 370⠀⁣⁣⁣ 🌏 Book online at espphysio.com⠀⁣⁣⁣ ⁣⁣⁣ Proud to support 🌐 ⁣⁣⁣ @stevenraymma ⁣⁣⁣ @dannyhenrymma ⁣⁣⁣ @tomstoltman⁣⁣⁣ @luke.stoltman⁣ @the_problem155⁣ ⁣⁣⁣ Affiliates 🌐 ⁣⁣⁣ @pulseroll – £10 off using code ESPPhysio10 ⁣⁣⁣ @stirlingcounty⁣ ➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖⁣⁣⁣ ⁣⁣⁣ #physiotherapy #physio #physioglasgow #physiostirling #physioedinburgh #physiofalkirk #espphysio #stirlingcountyrugbyfootballclub #footpain #plantarfascia #plantarfasciitis #heelpain #tightcalfs #calfstrain #tibialisposteriortendinopathy #physioadvice #mobility #exercises #flexibility #mobility #romwod #strength #espphysio #physioblog⁣

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Once the pain has mostly settled, and you have adequate mobility from the previous two exercises, the final step is to perform some strength work so that the foot can perform its original function 💯⁣ ⁣ This exercise is a modification of the standard calf raise which places more load through the plantar fascia (by keeping the big toe dorsiflexed) and surrounding foot muscles 💪🏻⁣ ⁣ Keep the big toe dorsiflexed by placing a rolled up towel on a step. Perform the heel raises by starting with the heel at the lowest point and ascend to the highest point possible. ⁣ ⁣ Take 3 seconds for each ascent and descent. Perform 10 reps, 2-3 sets, starting with once every 2-3 days and progressing to daily when the symptoms have improved.⁣ ⁣ When performing this exercise it is ok to experience some mild symptoms, and if so these should ease quickly after completing the exercise. However if you are concerned then stop ✋🏻 and drop us a DM for help 🆘⁣ ⁣ Tag anyone with heel pain 😀⁣ ⁣ ➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖⁣⁣⁣ 📲 Book by phone on 01324 227 370⠀⁣⁣⁣ 🌏 Book online at espphysio.com⠀⁣⁣⁣ ⁣⁣⁣ Proud to support 🌐 ⁣⁣⁣ @stevenraymma ⁣⁣⁣ @dannyhenrymma ⁣⁣⁣ @tomstoltman⁣⁣⁣ @luke.stoltman⁣ @the_problem155⁣ ⁣⁣⁣ Affiliates 🌐 ⁣⁣⁣ @pulseroll – £10 off using code ESPPhysio10 ⁣⁣⁣ @stirlingcounty⁣ ➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖⁣⁣⁣ ⁣⁣⁣ #physiotherapy #physio #physioglasgow #physiostirling #physioedinburgh #physiofalkirk #espphysio #stirlingcountyrugbyfootballclub #footpain #plantarfascia #plantarfasciitis #heelpain #tightcalfs #calfstrain #tibialisposteriortendinopathy #physioadvice #mobility #exercises #flexibility #mobility #romwod #strength #espphysio #physioblog⁣

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I have tried all these and it’s not working. What next?

This is when you should consider seeing a qualified health professional such as a Physiotherapist or Podiatrist. The key to treat unremitting plantar heel pain is to establish an accurate diagnosis of the structures involved and to rule out any further serious conditions. 

Here at ESP Physio, this will involve taking a full history taking followed by an assessment of the foot and ankle to identify the source of the pain and any causative factors. Based on the assessment findings, a bespoke treatment plan, which involves a combination of hand-on treatment and exercises along with activity modifications, will be discussed to allow you to take the first step towards a full recovery.

If this sounds good to you, then book yourself in for an appointment here at one of our physiotherapy clinics in Stirling, Grangemouth near Falkirk, Glasgow or Edinburgh! Alternatively, call us at 01324 227 370 and we will get you sorted!

References

Thomas, J. L., Christensen, J. C., Kravitz, S. R., Mendicino, R. W., Schuberth, J. M., Vanore, J. V., … & Baker, J. (2010). The diagnosis and treatment of heel pain: a clinical practice guideline–revision 2010. The Journal of Foot and Ankle Surgery49(3), S1-S19.

Hossain, M., & Makwana, N. (2011). “Not Plantar Fasciitis”: the differential diagnosis and management of heel pain syndrome. Orthopaedics and trauma25(3), 198-206.

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