• James McMurray

Are You A Runner Struggling with Heel Pain?

It is common for runners and people who works in a job that require many hours of standing to develop heel pain. One condition that it could be is plantar fasciitis. In the video below I will explain what Plantar Fasciitis is, how to diagnose it, and how to treat it. I also go through other conditions that could be causing your heel pain.


Presentation on Plantar Fasciitis:

Disclaimer:

This is not medical advice. The content is intended as educational content only. If you have any heel pain that is not getting better, then you should seek care of a medical professional.



Summary


Plantar Fasciitis is pain coming from the plantar fascia. Fascia is connective tissue that holds all the structures of your body together, such as organs, muscles. It is similar to a ligament. Plantar means sole of foot. The ‘itis’ in plantar fasciitis means ‘swelling’. However this can be misleading as there is true swelling, there is more a thickening of the plantar fascia that can be related to the pain there. Therefore, the name means: pain coming from the fascia in the sole of your foot.

The plantar fascia connects from the heel bone to the toes and helps maintain the arch of your foot and plays an important role in the biomechanics of your foot and ankle as you walk/run/jump.


Diagnosis

There are a few key symptoms that show you could have plantar fasciitis:

  • Pain in the morning after waking up when you first walk, but then this eases off the more you move

  • Pain when walking after sitting down for a long period of time, but eases the more you move

  • Pain when you poke the insertion of the plantar fascia onto the heel (put you finger on your heel, move it a few centimetres towards your toes just past the edge of the bone, then push down)

  • Pain when you push along the arch of your foot

  • Pain if you stretch your toes when your weight is going through that foot (Windlass test)



Treatment:

The key to treatment is to keep to the capacity vs load principle. You need to reduce your load so you are not putting your plantar fascia through too much work that it can handle. Then you need to strengthen your muscles to increase the capacity of the plantar fascia so it can handle the load of running.


Decreasing load:

The best thing you can do is activity modification. If you are a runner, don’t run into pain that is 4/10, or if the run causes a 4/10 pain 24 hours after the run, this will irritate the plantar fascia and stop it from recovering.

If you have a job that requires standing, it is best if you sit down as much as possible, or put a stall where you can rest your foot on.


Increasing capacity:

To start of it is best to do isometric exercises so you don’t cause any pain in the plantar fascia. Isometric exercises are where the muscle length doesn’t change when you contract it. You can do this by hanging your heels off the edge of a step. You can then progress this exercise by starting to raise your heel up and do a calf raise. From here you can increase the weight on your back by putting weight in a rucksack, or going to a gym.


Slow progression back to running:

Once the pain decreases and you have got adequate strength back, you need to make sure you don’t progress your training too quick, as this can increase your injury coming back.


Shockwave Therapy:

Shockwave therapy may be useful in people who have been suffering with plantar fasciitis for a long time 6 months to a year. It has not been found to have any benefit in people who have only be struggling with plantar fasciitis for a short amount of time. I have an article describing shockwave and its benefits planned to be published in the future, so keep out an eye for that one!


Differential Diagnosis:

Plantar Fascitiis pain can be similar to pain coming from other tissues/structures in the foot and ankle.


Stress fracture:

This is where the bone gets put through too much stress and tiny fractures occur in the bone. To differentiate a stress fracture from plantar fasciitis, there will be pain at rest and it doesn’t ease with activity. There will also be pinpoint pain on the bone. It may take 6 weeks for the bone to heal, in this time you will need to take complete rest from running, and may require an air boot to reduce load on the bone while walking.


Fat pad atrophy:

There is a fat pad that goes around the heel to help with cushioning. This can become thin with age causing pain on the bottom of the heel. To differentiate this from plantar fasciitis, the pain will not ease with activity, and the pain may be more on the bottom centre of the heel bone rather than on the soft spot under the foot where the plantar fascia is.


Neural pain:

A nerve runs down the inside of the ankle called the tibial nerve that runs through a space called the tarsal tunnel. The tarsal tunnel may become too small due to several reasons, which can irritate the nerve and cause nerve pain in the foot. If you have a pins and needles, numbness or weird sensations on the inside of the ankle, it could be due to the tibial nerve.


Insertion Achilles Tendinopathy:

Achilles Tendinopathy is where you overload the tendon to more than you can handle which causes cellular change in the tendon which makes it weak and sensitive. If you get these cellular changes on the tendon that inserts onto the bone then you will get pain into the back of the heel.


If you have any questions about plantar fasciitis, then feel free to get in touch.

James

Sport and Exercises Health Science BSc

Physiotherapy BSc



References:

Schwartz, E. N., & Su, J. (2014). Plantar fasciitis: a concise review. The Permanente journal, 18(1), e105–e107. https://doi.org/10.7812/TPP/13-113

Goff, J. D., & Crawford, R. (2011). Diagnosis and treatment of plantar fasciitis. American family physician, 84(6), 676–682.

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