Heel pain is a very common complaint I see in the clinic. In the age of Google, it is common for people to self-diagnose their heel pain as being due to Plantar fasciitis. Often to their detriment.
There are many other causes of heel pain. I will discuss effective treatment protocols for Plantar Fasciitis here, as well as mention some of the other common causes of heel pain.
Plantar Fasciitis is one of the most common causes of heel and sometimes arch pain. One of the classic symptoms is a pain in the heel after a period of rest or first thing in the morning.
The Plantar Fascia itself is a thick band of connective tissue that runs along the bottom of the foot from the base of the heel to the base of the metatarsal bones. The inner portion of the Plantar Fascia runs from the heel to the base of the big toe and represents the most commonly injured part of the band.
Plantar Fasciitis is an inflammation of this band causing pain on weight-bearing predominantly.
Also connecting to the Plantar Fascia are other intrinsic muscles of the arch of the foot. The Flexor Digirorum Brevis (FDB) is one such muscle. These muscles along with the Plantar Fascia, play an important role in supporting the longitudinal arch of the foot and propelling the body forward during gait.
Commonly treatment focus only on stretching and strengthening the Plantar Fascia, without addressing deficits in the other important intrinsic muscles located in the arch of the foot.
My recommendations for treatment of Plantar Fasciitis include:
1. A series of specific stretching and high-load strengthening exercises.
-Single heel raises with the toe flexed is a great exercise. The aim is to gradually increase the number and load as tolerated. The use of a Fasciitis Fighter Device is helpful here.
- Another effective exercise is to simply stretch the big toe and hold this for 10 sec 30 times a day.
- Stretching tight calf muscles is imperative. The use of a night brace is helpful here.
2. Strengthening the Peroneal muscles which are located on the outer side of the foot and ankle. Use of a resistance band is helpful here.
3. Strengthening of the lesser toe muscles (toes 2-5) - this is where the FDB muscle attaches.
4. Orthotic therapy.
Heel spurs commonly occur as a result of Plantar Fasciitis. however, spurs can occur without Plantar Fasciitis. A spur is defined as a bony growth that develops at the base of the heel. It was commonly accepted that the spur formed at the attachment site of the Plantar Fascia. More recent research suggests that the spur is formed at the attachment site of the FDB muscle.
Other relatively common causes of heel pain are:
- Heel spurs
- Calcaneal stress fractures
- Baxters nerve entrapment
- Hagland's Deformity
- Bursitis
- Achilles Tendinitis
- Bone tumor
As mentioned there are several other conditions that can cause heel pain and symptoms. I strongly recommend professional assessment and diagnosis.