Foot-X-ray

This prickly problem has cropped up several times in the past few weeks in my clinic, so I thought it’s high time to address the issue!  Heel pain can turn up “out of the blue”, and likes to hang around, given the chance.  When I refer to “heel” pain, I’m really talking about pain under the foot, most commonly around the front edge of the heel bone, sometimes travelling up under the arch towards the toes.  This is mostly a burning, achy pain, and can leave you hobbling around, trying to walk without putting your heel down, and it’s often bad first thing in the morning.  The pain comes from the “plantar fascia”, a band of connective tissue like a ligament, that stretches from the heel bone to the ball of your foot.  It supports the foot arch, and helps with the springy flexibility of the foot. There are other kinds of foot pain; if you’re suffering with pain in the back of the heel, the most likely culprit is the Achilles tendon; if it’s a sharp, stabbing pain in the midfoot region with tingling and pain shooting into the toes, you could be looking at a Morton’s neuroma – an irritation of the digital nerve as it passes between the bones of the foot.  Heel pain may also result from fracture in the heel bone, irritation of the nerve that runs under the foot, often where it curves round the ankle bone, or loss of the protective pad of fat under the heel.  To have your foot pain properly assessed, you should check in with your GP, therapist, or podiatrist.

So, “plantar fasciitis” (as it’s handily known!  Pronounced “fash-ee-eye-tis”) is a pretty common problem.  It tends to occur more often in people who’ve recently taken up an activity or job that means more time on their feet – runners, soldiers, or sometimes checkout cashiers – and also in people of “a certain age” (it peaks around 40-60 years).  In fact, even amongst the athletes, age increases the risk.  Although the “-itis” ending to the name implies inflammation (as in “tonsillitis” – inflamed tonsils), the age-factor shows up the role here of wear-and-tear.  The stuff that the plantar fascia is made from, collagen, has been shown to lose its elasticity as we get older, and the constant stress it’s under (taking our weight all the time!) means that it doesn’t always repair as well as it should.  Add in that New Year’s resolution of a daily jog, and it’s no surprise symptoms start to appear.

If you’re the 45-year old newest recruit of the local marching band, then, you’re probably wondering how you’re going to avoid this unpleasant situation.  Well, there’s a few precautions you can take…

  1. Decent footwear, with arch support and a slight heel raise, will help take off the pressure.
  2. Stretch your legs and ankles.  Calf-stretches are easy to do and will help your feet to function at their best.
  3. Work your toes.  The small muscles in the sole of your foot can take some of the load off the plantar fascia.  Keep them in good shape by flexing your toes (try putting the front half of your foot on a large tissue on the floor, and then scrunch the tissue up using your toes.)

And if you’re already suffering?  First, make sure you get your foot checked to rule out other causes.  Then, here’s a few extra suggestions:

  1. Rest.  OK, I know that’s not terribly practical for most of us, but at least ease off as much as you can on those activities that aggravate the problem – swap in another form of exercise if you need to, such as swimming.
  2. Self-massage the sole of your foot, using a small ball like a squash ball to roll your foot on.  Or, some people really find cold helpful, so instead roll your foot on a small frozen bottle of water for ten minutes or so.
  3. See a therapist (physio, chiropractor, osteopath).  They can check if you have stiff joints in your feet that will put more stress on the plantar fascia, or if there are postural issues that are affecting the way your foot is functioning.
  4. A good massage might also help to loosen you up and stop strain on your foot from tight muscles.

You’ll be back on your feet in no time!

5 Comments

  1. Free Range Pilates on January 21, 2014 at 9:45 am

    Reblogged this on FreeRangePilates and commented:
    I recently had the joy of heel pain due to tendonosis of my achilles tendon, which is essentially the tendon degrading. Oh the joys of getting older. Thankfully exercise is very effective for this condition, particularly eccentric loading where the muscle slowly lengthens under load. The solution was calf raises on the affected foot, using the other foot to help the lift up to your toes phase and then having all the body weight through the affected ankle for the slower lowering phase. Worked a treat, my achilles tendon is now clearly really buff! (Showing my age again with 90’s slang)

    • diana on November 18, 2015 at 7:40 pm

      Thanks Jon! A bit of 90’s slang never hurt anyone… 🙂

  2. w88 on September 8, 2014 at 11:46 am

    Hello! I bookmarked it to my computer:) Nice post.

    • diana on November 18, 2015 at 7:41 pm

      Thank you – glad you enjoyed it.

  3. diana on November 18, 2015 at 7:36 pm

    I’ve had a message asking about Sever’s disease (or “calcaneal apophysitis”), a similar condition affecting the heel bone that shows up in children (usually around 8-10 years in girls and 10-12 years in boys). There are two main elements that can lead to its development – activity level (it’s more prevalent in highly active children) and biomechanics (poor ankle mobility or arch control, or tight muscles in the legs, can predispose to Sever’s as well). My advice would be: first – get it properly diagnosed; second – use anti-inflammatories / ice pack and rest during the actively painful phase; third – seek treatment to ensure the ankle and foot joints are working properly, and get advice from a podiatrist on a soft heel cup or orthotic to take the pressure off the heel; fourth – make sure your child is warming up and stretching well especially before / after exercise. Sometimes there are issues higher up, in the leg or hip, that mean the foot isn’t being properly controlled, so rehabilitative or proprioceptive exercises may play a part too. A good therapist can advise you what’s appropriate. Good luck!

Leave a Comment