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Plantar Heel Pain Management and Treatment

PODIATRY NEWS & REVIEW:

By Columnist Andrea Castello – Biomechanical, Sports and Paediatric Podiatrist:

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Plantar heel pain, commonly referred to as “plantar fasciitis”, is defined as pain or discomfort in the bottom of the heel. It is generally characterised in its early stages by pain or discomfort when rising from rest, especially if a lot of time has been spent on the heel during the day. In the case of morning pain, it will generally occur if a big day was had the day before.

Symptoms of Plantar Heel Pain

In its infancy this discomfort seems to settle after a couple of minutes of walking around. However if the problem is left to worsen, it can get to a stage where any type of weight bearing activity is painful. I have seen cases where patients have had to resort to the use of crutches and moonboots just to perform basic daily tasks.

Plantar heel pain can be caused by many different risk factors. The main factors I see are a sudden change in activities, such as increased walking, running, jumping, employment that requires more standing, and changes in footwear. Some people are predisposed to plantar heel pain because of biomechanics – poor foot function or poor proximal hip stability – or systemic factors – age, menopause, elevated cholesterol, increased susceptibility to pain, weight. Predisposed people may develop plantar heel pain with even subtle changes in their activity.

Treatment for Plantar Heel Pain

When treating the plantar heel pain, my primary aims are to address two main issues. The first is to reduce compressive load -squashing-up against the bottom of the calcaneus or heel bone – and the second is to reduce shear forces around the heel generally increased by foot function or footwear.

I feel it is important to address plantar heel pain as soon as possible and to be aggressive with treatment. Generally speaking, the longer a patient has this problem, then the longer it will take to resolve.

My general treatment plan for Plantar Heel Pain is as follows:

  • Taping in the first instance. In particular to support the fat pad under the heel so it can act as a “cushion” and reduce the compressive load on the heel.
  • Footwear change. This does depend on the foot type we are treating, however the main aims are to reduce the compressive and shear forces on the heel.
  • Strengthening program for the small muscles of the foot.
  • Calf muscle stretching.
  • Manual Therapy to increase the ankle’s range of motion.
  • Dry Needling of the intrinsic muscles to treat painful trigger points.
  • Orthoses. We now have evidence that custom foot orthoses provide for much better outcome at 12-weeks than exercises and footwear changes alone and in my experience can resolve 95% of cases.

If these interventions fail, which may be the case if the problem is long standing, then other interventions include the following:

Plantar heel pain is a health issue that left without treatment can become debilitating. My advice is if you are suffering with this or something similar, please don’t hesitate in seeking assistance. The sooner it is addressed the sooner you can get back to doing what you love doing, pain free.

About Our Podiatry News and Review Columnist

AC Podiatry (19 of 20)Andrea Castello graduated from the University of South Australia in 1999 and has worked in the public and private sectors in both the country and the city. After completing a Masters Degree in Health Services Management in 2006, Andrea decided it was time to put his education to work and start his own practice, which culminated in the inception of AC Podiatry in late 2007. Since then it has grown to include 8 clinics employing 11 podiatrists.

As a podiatrist, Andrea has spent much of his professional career refining his skills with particular attention given to biomechanical, sports and paediatric podiatry. In addition to standard podiatric skills, Andrea has also completed numerous workshops in Dry Needling and Mobilisation. He is a member of Sports Medicine Australia, the Australasian Academy of Podiatric Sports Medicine, a Mentor to final year students and new graduates, and is currently the podiatrist for the Central District Football Club in the South Australian National Football League.

Disclaimer: The information published in this column are based on the author’s own professional and personal knowledge, and opinion. This information and opinion is not intended to be a substitute for professional medical advice, diagnosis or treatment of any manner. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition and consult a qualified medical professional before beginning any nutritional program or exercise program. Never disregard professional medical advice or delay in seeking it because of something you have read on InShape News.

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