Heel Pain Part 1 – Plantar Fasciitis
Recently a client asked me “is having heel pain first thing in the morning, just one of those things you have to put up with as you get older”?.
What are the causes of Heel Pain?
There are two major causes of heel pain, firstly a grumbling Achilles Tendon and secondly Plantar Fasciitis. This week I am going to focus on Plantar Fasciitis. Plantar Fasciitis is inflammation of the Plantar Fascia or the strong band of tissue on the sole of your foot that stretches from your heel to your toes that supports the arch of your foot and acts as a shock absorber when you walk. The usual site of the pain with Plantar Fasciitis is on the sole of the foot, see diagram below.
How can I tell if my heel pain is Plantar Fasciitis?
Plantar Fasciitis is characterised by the gradual onset of soreness and aching under the heel at its mid-point, which spreads forward along the inner side of the arch of the foot. The ache or pain is often for the first few steps when you get out of bed every morning or after sitting at your desk for a long period of time.
What causes Plantar Fasciitis
- Sedentary Lifestyles
- Being overweight
- Wearing shoes with too little arch support or cushioning
- Vigorous take off’s, landings are fast turns during weight bearing sports.
- Wearing high heels too much.
- Excessive foot eversion (your weight is too much on the outside of your foot).
What can I do to help myself?
If you are in pain, then simply rest and ice. A simple solution is to freeze a plastic water bottle which is about 75% full of water – when it is frozen wrap it in a tea towel, so you don’t burn your skin and roll it under the sole of your feet to provide pain relief.
The following exercises, done either with or without shoes on, can be used to help treat Plantar Fasciitis:
- Stand about 40 cm away from a wall and put both hands on the wall at shoulder height, feet slightly apart, with one foot in front of the other. Bend your front knee but keep your back knee straight and lean in towards the wall to stretch. You should feel your calf muscle tighten. Keep this position for several seconds, then relax. Do this about 10 times then switch to the other leg. Now repeat the same exercise for both legs but this time, bring your back foot forward slightly so that your back knee is also slightly bent. Lean against the wall as before, keep the position, relax and then repeat 10 times before switching to the other leg. Repeat this routine twice a day.
- Stand on the bottom step of some stairs with your legs slightly apart and with your heels just off the end of the step. Hold the stair rails for support. Lower your heels, keeping your knees straight. Again you should feel the stretch in your calves. Keep the position for 20-60 seconds, then relax. Repeat six times. Try to do this exercise twice a day.
- Sit on the floor with your legs out in front of you. Loop a towel around the ball of one of your feet. With your knee straight, pull your toes towards your nose. Hold the position for 30 seconds and repeat three times. Repeat the same exercise for the other foot. Try to do this once a day.
- Sit on a chair with your knees bent at right angles and your feet and heels flat on the floor. Lift your foot upwards, keeping your heel on the floor. Hold the position for a few seconds and then relax. Repeat about 10 times. Try to do this exercise five to six times a day.
- For this exercise you need an object such as a rolling pin or a drinks can. Whilst sitting in a chair, put the object under the arch of your foot. Roll the arch of your foot over the object in different directions. Perform this exercise for a few minutes for each foot at least twice a day. This exercise is best done without shoes on.
Finally, a deep tissue massage to the calf muscles, achilles tendon and foot will help too.
Related Posts
Stretches for Head, Neck and Shoulders
These stretches can either be done as a complete series or individually and most of them can be done at your desk. Some will ease tension in specific parts of the body whilst others are generally relaxing. Please remember stretching should always be relaxing and never painful! To get maximum benefit from these stretches you should do them daily and hold each stretch for 15 seconds and repeat twice. Head And Neck
- Head rotation - keeping your head level, slowly turn from side to side.
- Slowly drop your head sideways moving your right ear towards your right shoulder and push down with your left shoulder - repeat on other side.
- Stand with your feet shoulder distance apart; look down towards your right foot (hold for 15 seconds), dropping left shoulder - repeat the exercise looking towards your left foot.
- Drop the lower jaw and open the mouth wide.
- Shrugging shoulders in a circular movement - forwards and then backwards.
- Raise your shoulders high and let them drap heavily; whilst letting breathing out.
- Clasp hands behind your head, with elbows back - push your chin back. Hold for 15 seconds. From this position look down and push your elbows together at the front and hold for a further 15 seconds.
- Clasp you hands and push up towards the ceiling, palms up now look down.
- Sit upright in a chair with a firm seat. Raise your arms as high as possible and remaining seated drop forward letting your head and arms hang heavily towards the floor.
So how does massage reduce pain? – Part 1
I said in a previous post that scientists are interested in finding out how massage works. So if we accept that massage reduces muscle pain, that leaves the question, "How does massage reduce muscle pain?". In 1965, Ronald Melzack and Patrick Wall outlined a scientific theory about psychological influence on pain perception; the ‘gate control theory’. According to the gate control theory, pain signals are not free to reach the brain as soon as they are generated at the injured tissues or sites. They need to encounter certain ‘neurological gates’ at the spinal cord level and these gates determine whether the pain signals should reach the brain or not. In other words, pain is perceived when the gate gives way to the pain signals and it is less intense or not at all perceived when the gate closes for the signals to pass through. Cutaneous mechano-receptors are stimulated by touch (massage) and transmit information within large never fibres to the spinal cord. These impulses block the passage of painful stimuli entering the same spinal segment along small, slowly conducting neurons. This theory gives the explanation for why someone finds relief by rubbing or massaging an injured or a painful area. For example, the pain gate theory explains "how" a child feels better after mum or dad intuitively rub their knee when they have fallen over. In summary massage produces short term pain relief by being a particularly effective trigger for the pain gate process. References Melzack R, & Wall PD (1965). Pain mechanisms: a new theory. Science (New York, N.Y.), 150 (3699), 971-9 Moayedi M, & Davis KD (2013). Theories of pain: from specificity to gate control. Journal of neurophysiology, 109 (1), 5-12 Jacobs M. (1960) Massage for the relief of pain: anatomical and physiological considerations. Physical Therapy Review, 40: 93-8 Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965 Nov 19;150(3699):971–979. Wells PE, Frampton V, Bowsher D. (1988) Pain: Management and Control in Physiotherapy. Heinemann Medical. Chapter 13. Watson J. (1982) Pain mechanisms: a review. 1. Characteristics of the peripheral receptors. Australian Journal of Physiotherapy. 27:135-43
Top tips for preventing sports injuries
Many sports injuries occur because people don't know how to prevent them. Here are some tips to help prevent injuries:
- Always wear the correct gear. Players should always wear appropriate and properly fitted protective sports gear such as pads (neck, shoulder, elbow, chest, knee, shin), helmets, mouthpieces, face guards, protective cups, and/or eye wear.
- Increase muscle strength.
- Increase flexibility. Stretch!
- Use the proper technique.
- Take rests.
- Follow the rules of your sport and play safe.
- Stop the activity if there is pain.
- Keep hydrated.
