Arch and heel pain treatment in Esperance
Pain under the heel is one of the most common problems we see at Esperance Podiatry. The most frequent cause is plantar fasciitis, also called plantar fasciopathy or plantar heel pain. It can make that first step out of bed in the morning, or after sitting for a while, genuinely painful.
The good news is that most people improve with the right management. It's important to get an accurate diagnosis first, though, as heel pain has many possible causes.
What is the plantar fascia?
The plantar fascia is a strong band of connective tissue on the sole of your foot. It runs from the underside of your heel bone to the base of your toes. It's about 12 cm long, around 2 cm wide at the heel, widening to about 6 cm at the toes, and roughly 4 mm thick.
It's a bit of a hybrid tissue: it behaves like a ligament but stretches and recoils more, and at a cellular level it's most similar to a tendon. Its jobs include:
supporting the arch and resisting it flattening
turning the foot into a rigid lever so you can push off when you walk and run
helping keep the toes straight
storing and releasing elastic energy with every step
It's also closely linked to your Achilles tendon and calf muscles, which is one reason tight calves often go hand in hand with heel pain.
Read more: The Structure and Function of the Plantar Fascia
Signs of plantar fasciitis
Pain under the heel, sometimes spreading into the arch
Pain that's worst with the first steps in the morning, or after sitting or resting, then eases as you get moving
Pain that builds again after a long time on your feet, or after exercise rather than during it
Tenderness when pressing on the inside of the heel
Often worse after a change in activity, footwear or surfaces
Other causes of heel pain
Not all heel pain is plantar fasciitis, and getting the diagnosis right matters because the treatment differs. Other causes we look for include:
problems with the heel fat pad
irritation of the small muscles in the sole of the foot
problems with tendons that attach into the foot, including the Achilles tendon
stress fractures of the heel bone
nerve irritation in the foot, or referred from the lower back
in children and teenagers, irritation of the heel's growth plate
Rebecca will take a full history and examine your foot to work out what's really causing your pain.
Why does it happen?
Too much load for the tissue
Plantar fasciitis is best understood as a mechanical overload. The plantar fascia is designed to take a lot of load, but when the load is more than it can adapt to, the tissue starts to break down. That load can come from stretching (tension), squashing (compression), bending or shearing forces, usually a combination.
Read more: What Forces Damage the Plantar Fascia, and Why?
It's usually not inflammation
Despite the name, most cases of plantar "fasciitis" show little or sometimes no inflammation. Under the microscope, the tissue shows degenerative changes instead: disorganised collagen fibres, a softer, stretchier tissue, and sometimes calcification where it attaches to the heel. That's why the term plantar fasciopathy is now preferred. It also explains why treatments that only target inflammation often don't solve the problem.
Read more: Plantar Fasciitis Under the Microscope
What about heel spurs?
Heel spurs are common on X-rays, but they're usually not the cause of pain. Plenty of people have spurs without any pain, and plenty have heel pain without spurs. A spur is a sign the area has been under load for a long time, and it rarely needs treating in its own right.
Risk factors
There's no single cause that explains every case. Factors that may contribute include:
a sudden increase in walking, running or standing
long hours standing or walking on hard surfaces, or jumping down from vehicles and machinery
tight calf muscles or Achilles tendon
footwear that doesn't suit your feet or activity
body weight, age and general health
previous injuries
The research on many of these is mixed, so Rebecca looks at your situation as a whole rather than assuming one cause.
How we assess heel and arch pain
At your appointment, Rebecca will:
ask about your pain, your activity, your work and your general health
examine your foot and leg, including the plantar fascia, heel, calf and Achilles tendon
look at how you walk, and at your footwear (bring your most-worn shoes)
rule out other causes of heel pain
Most people don't need scans. If the diagnosis isn't clear or you're not improving as expected, Rebecca may refer you for imaging such as an ultrasound.
Treatment
Because plantar fasciitis is a load problem, treatment focuses on calming the tissue down, then gradually building its capacity to handle load again. Your plan will be tailored to you, and may include:
Managing load: adjusting how much and what kind of walking, standing, running or exercise you do, without stopping altogether
Footwear advice: shoes that suit your feet and your activities
Short-term pain relief: such as taping, heel cushions or off-the-shelf orthotics
Foot orthoses: off-the-shelf or custom-made, to reduce strain on the plantar fascia
Adjunct physical modalities: Laser and shockwave therapy can help to settle the painful tissue
Exercise therapy: progressive strengthening of the foot and calf, and calf flexibility, to build the tissue's tolerance to load
Addressing contributing factors: such as work demands, training habits or general health
Plantar fasciitis can take time to settle, often several months, especially if it's been around for a while. Sticking with your exercises and a gradual return to activity give you the best chance of a lasting recovery.
Arch and heel pain in runners and football players
Runners often develop heel pain after a change in their training, such as more distance, more speed, hills or new shoes. Football players often develop plantar fasciitis at the start of training where they’ve changed out of workboots and sneakers and into their flat footy boots. We look at your training load, running history and footwear, and work with you to keep you running and training where possible while the tissue recovers, then build back up.
Book an appointment
If heel pain is slowing you down, book in with Rebecca at Esperance Podiatry. No referral is needed.
Call (08) 9072 1514 or visit us at Suite B, 116 Dempster Street, Esperance.