5 Steps to Help Treat Heel Pain

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5 Step Guide for Treating Plantar Fasciitis and Heel Pain

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Plantar fasciitis or inflammation of the plantar fascia comes about when the ligament suffers very small tears where it inserts into the heel bone, or along its length. With poor foot mechanics, too much use or the presence of other triggers, the pressure on the plantar fascia during the process of walking and running can tear the fascia from where it joins to the heel and develop microscopic tears. This can lead to heel spurs which are easily detected with x-rays.

The most common complaint of heel pain is that it is usually worst in the morning and may improve throughout the day. By the end of the day the pain may be replaced by a dull aching that improves with rest.

If you have seen your doctor about this he or she may prescribe rest and anti-inflammatory medication for the first part of treatment but there are some very conservative and non-invasive treatment methods to manage and eliminate this heel pain.

If you have not seen your doctor but answer YES to any of the following questions then you might be suffering from Plantar Fasciitis or Heel Spur Syndrome.

1. Do you have heel pain after rest or sitting?

2. First few steps in the morning are painful?

3. Does it feel like you have a stone under your heel?

4. Does your heel hurt when you press on the bottom?

After the end of the initial rest and recovery stage, treatment can begin, tackling the problem with multiple techniques. These may involve icing, taping, specific stretches,

This information provided by Kinetic Konnection is not intended to replace the medical advice of your doctor or health care provider. Please consult with your health care provider for advice about a specific medical condition.

Kinetic Konnection – www.thebracingexperts.com 2 5 Steps to help treat heel pain massage, resting splints, insoles or custom foot orthotics and proper footwear. It may take several months for symptoms to go away and the plantar fascia to be completely healed. Remember that a damaged ligament (even microscopic tears) only comes about after recurring and prolonged stress. The longer someone has been suffering from plantar fasciitis and the worse the heel pain, the longer the treatment will take. Using a combination of treatments will shorten the recovery time and get you back to pain free activities sooner.

Five Step Guide for Treating Plantar Fasciitis

Before you get started with any treatment plan please speak with your physician or foot specialist about your condition or diagnosis. These steps are simple, effective, non-invasive, and conservative and work best in combination. Your feet will soon be happy again!

Step #1 - Icing

Plantar Fasciitis is an inflammatory condition. Often your doctor will prescribe anti- inflammatory medication for pain and help control the inflammation. Icing 2 to 4 times a day will also help with the pain and inflammation. There are several ways to effectively ice the area.

• Use a tensor bandage to wrap a bag of ice to your heel. Do not apply too tight and place a thin cloth barrier between the ice and your skin to avoid skin damage. • Freeze a 500 ml water bottle. Place the bottle under your foot and roll it back and fourth. Heel to toes. This will ice and massage the heel and arch. You may want to use a thin sock if it is too cold.

• Ice Tape. Wrap your foot as if you sprained it. The Ice Tape provides compression and as it begins to evaporate it will get colder but not cold enough to cause skin irritations. Ice Tape can be left on for extended periods of time and is reusable.

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• Dixie or Styrofoam cups. Fill them with water and freeze. Before application tear off the top ½ inch of the cup to expose the ice. Gently rub and massage the pain area. This icing technique is very specific to the heel area. Step #2 - Resting and Night Splints

Damage to the plantar fascia usually occurs over a period of time while the tissue is being stretched too much causing micro tears. When we rest or while we sleep the micro tears begin to heal but in a shortened relaxed position. We when rise and become weight bearing we cause the plantar fascia to stretch again and consequently tear what was trying to heal. A night or resting splint will keep the foot in a neutral position (90 degrees) allowing the tissue to heal at a normal length. This will eliminate the pain in the first few steps after sleeping or resting. It also breaks down the cycle of healing – tearing – healing – tearing which creates scar tissue and can lead to heel spur syndrome.

Types of night splints – there are two types that are most effective, comfortable and affordable. There are many others available just make sure it keeps your foot at 90 degrees and is comfortable.

• Dorsal Type Night Splint. This splint goes on top of the foot and slightly up the shin bone. It is made of rigid material to help maintain a neutral position. This material is also adjustable to increase or decrease the angle of the foot. There are no hard or bulky surfaces to contact the opposing leg during sleep. Very easy to use and comfortable.

• Traditional Adjustable Night Splint. The splint goes under the foot and up the calf area. Adjustable straps allow for an increase or decrease in the angle of the foot. Front buckle straps keeps the foot and ankle securely in place for optimal position.

Both splints are very effective. One might suit you better. Be sure to get fitted properly by a trained fitter.

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Step #3 - Stretching

It is important to avoid overly aggressive stretching at the start of the treatment as this can re-injure the plantar fascia. Stretching should be done within a range of motion that is pain free. The following stretches are basic and easy and should be followed by icing. For more advanced stretches you can contact us or see your physical therapist who can give you personalized instruction in a series of stretching exercises.

• Wall Stretch

A wall stretch can help to stretch the calf and muscles in the foot. Firmly plant your hands on a wall in front of you with your arms fully extended. Move one foot in front of the other. The foot with plantar fasciitis should remain in back. Slightly bend your knee on the leg in back. Hold this position until you feel your calf muscles stretching. Hold this position for 30 seconds.

• Stair Stretches

The American Academy of Family Physicians recommends using the stairs in your home to help stretch. Stand on the stairs and alternate dropping each heel below the stair level to help loosen the plantar fascia and the Achilles tendon. If you do not have stairs, you can stand on a block for the same effect.

• Non-Weight-Bearing Stretches

If your foot is extremely painful, weight-bearing stretches may not be tolerable. The University of Michigan suggests sitting on the floor and wrapping a towel around the bottom of your foot so you can pull your toes toward you. You also can sit in a chair, cross your legs and use your fingers to pull your toes up. Both of these exercises will stretch out the bottom of your foot. Make sure you apply only enough pressure to create a gentle stretch.

• Foot Roll

This exercise not only stretches the plantar fascia but also provides a massage for the bottom of your foot. Place a tennis ball, can of soup or other round object under your foot and roll it from your toes to your heel. It is best to do this seated. If your foot is painful or inflamed, place the object in the refrigerator or freezer, so you can give your foot an ice massage as well.

References • American Academy of Orthopaedic Surgeons: Plantar Fasciitis • American Academy of Family Physicians: Treatment of Plantar Fasciitis • University of Michigan Health System: Plantar Fasciitis Rehabilitation Exercises

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Step #4 - Proper Footwear

This step is easier than most think. Proper foot wear is important even for those who do not suffer heel pain. Yes, I know we all have different shoes that we need for different occasions and we can’t all wear running shoes to work, but follow these 3 golden rules for sourcing out proper footwear and your feet will thank you.

1. Make sure you get sized accurately. 2. Get sized at the end of the day when your foot is the largest.

3. Don’t lie about your foot size or width.

Here are the top 4 Test to help deciding what shoe you should buy.

1. “Heel-Counter Thumb” • In this test, one holds the shoe in one hand, while they use the thumb of the other hand to push in the back part of the heel counter. In a shoe not designed to assist over-pronation problems, this aspect of the shoe will fold very easily. A good shoe will not fold at all.

2. “Heel Counter Pinch” • In this test, one holds the shoe in one hand, while they squeeze the heel area together with the index finger and thumb. In a shoe not designed to assist over-pronation problems, the sides of the upper will fold very easily. A good shoe will not fold at all.

3. “Dish Rag” • To do this test, grip the front part of the shoe with one hand and the back part with the other hand. Then twist the shoe in opposite directions. A good shoe will be resistant to these forces. A poor shoe will fold up like a dish rag. 4. “Fold” • A good shoe should be able to fold at the balls of the feet (where the toes connect to the rest of the foot). This allows for proper toe-of during walking and running. A shoe that folds in other places such as the middle should be avoided.

A shoe that passes these four tests will provide superior support and compliment an orthotic that is designed to relieve symptoms produced by over pronation. If an orthotic is resting on an unstable environment, it will not be able to perform its function thus limiting its ability to relieve the pain and symptoms. This information provided by Kinetic Konnection is not intended to replace the medical advice of your doctor or health care provider. Please consult with your health care provider for advice about a specific medical condition.

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Step #5 - Custom or off the shelf foot orthotics

Orthotic insoles are a device placed inside your shoes with the purpose of correcting faulty foot function. Poor foot biomechanics can be blamed for many common foot conditions such as Plantar Fasciitis (heel pain) and Metatarsalgia (ball of foot pain).

The most common display of faulty foot biomechanics is 'over-pronation'. Over- pronation is a condition whereby the arches are lowered and the feet and ankles roll inwards excessively during walking and running. Over-pronation should not be confused with flat feet (Pes Planus). Over-pronators do have an arch present, but the arch will lower significantly during walking and standing – causing the fascia to become over stretched. Orthotics are designed to correct the faulty foot function. In turn this will reduce the amount stress place on the fascia. By correcting over-pronation orthotics re-align the feet and ankle bones to their neutral position, restoring our natural foot function. Therefore, orthotics not only help alleviate problems in the feet but also in other parts of the body such as the knees and lower back.

There are many types of orthotics available and several casting and measuring techniques. There are some questions you should ask before getting your foot orthotics.

1. What are the credentials of the person who will be responsible for

my custom orthotics? • You want to make sure that they have training in biomechanics, pathologies and anatomy of the foot. Podiatrists, Chiropodists, Pedorthists and Kinesiologists are recommended.

2. What are the methods for creating my custom orthotics? • Metascan dynamic software scans the foot 150 times per second tracking 8 key points along the plantar surface of the foot. Gait observations show each of the 8 key points relative to pressure and time in a color corresponding to the 2D and 3D composite image and displays gait analysis data. This type of orthotic is typically for those who fall into a normal range of foot function with mild biomechanical deficiencies. This information provided by Kinetic Konnection is not intended to replace the medical advice of your doctor or health care provider. Please consult with your health care provider for advice about a specific medical condition.

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• Slipper casting is similar to plaster except that it is less messy and time consuming. It is in a sock not fabric roll format and leaves no residue on the client's foot since a bag is placed over the foot first. By capturing the correct foot position (subtalar joint in neutral) in the cast this technique is great for those who require additional correction. This is usually taken non-weight bearing.

• Foam box impressions involve pushing the foot into a foam box (with subtalar joint in neutral) either from a standing or seated position. This can be a semi-weight bearing or full-weight bearing technique often used if someone requires a less aggressive (more accommodative) shell shape. It is often used for people with severe arthritics or diabetics (sores on foot).

3. Will these orthotics fit into my shoes? • Orthotics can be designed for virtually any shoe type but are usually designed with a particular shoe type in mind. Depending on your needs they should work well with shoes of similar style. If an orthotic is designed for running shoes, it will not fit properly into a heeled shoe. Sandals also restrict orthotic use, as the orthotic is not secure without a closed shoe.

4. What happens if I need an adjustment or modification? • Make sure that your provider will allow for adjustments and modifications for the first year at NO CHARGE. The body’s response to the inserts is sometimes unpredictable and adjustments may be needed even after you have worn them for a while.

You can get more information or book a consultation with our Kinesiologists or Foot Specialists by following the links below.

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