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Heel Pain: Know How It Works So You Can Get Rid of It - 9 Sept

Heel pain is usually just over-stressed tissue at the heel. Specifically, we are referring to the plantar fascia, the taut band of tissue that connects the heel to the forefoot and causes the arch of the foot to form.

Doctors used to refer to this condition as plantar fasciitis, but the term is a misnomer, so we are trying to get away from it. Fasciitis means inflammation, but we now know that inflammation is not an important part of what is going on. It’s more of a degenerative process – or a healing response that can’t keep up with daily stresses. Therefore, plantar fasciosis is a better term. Eight out of ten heel pain cases presented to orthopaedic practices turn out to be simple cases of plantar fasciosis.

Heel Spurs Don't Hurt

The research is conclusive. Heel spurs do not cause heel pain. Heel spurs are the pointy bone formations that occur where the plantar fascia is pulling on the heel. This bone remodeling signifies stress on the heel, but there are many people with heel spurs who do not experience heel pain. The heel pain is still from the degenerative process occurring in the fascia. Therefore, even when heel spurs are detected, for best results, most heel pain should be treated as plantar fasciosis.

It’s Not Inflammation

Since it’s not inflammation, there are several treatments that aren’t actually helping. Anti-inflammatory pills such as aspirin may provide temporary pain relief, but they aren’t doing anything to resolve the situation. Ice does not have a lot of support in the literature, but it could theoretically be helpful. It wouldn’t help by reducing the inflammation. It may help by improving circulation. The body responds to ice by briefly improving circulation to an area to try to warm it back up. That increased blood flow brings higher volumes of beneficial healing factors. However, more is not better. After ice has been on for too long, the body switches strategies. It withholds blood flow to protect the temperature of the rest of the body. Reduced blood flow is the opposite of what would be helpful.

Is Heel Pain Self-Limiting?

A lot of people think heel pain is no big deal: “It will go away on its own if I just take it easy.” There is some truth to this, but that’s not the whole truth. As a degenerative condition, heel pain tends toward chronicity and recurrence. One in five cases is still painful after a year. Heel pain can progress to a mildly disabling condition affecting work, fitness, and general happiness. 

what works for Heel Pain?

There are a lot of theories and treatments out there, but only a few have quality studies proving their effectiveness. Here are the top, proven strategies for heel pain. Contact us if you would like to have the scientific references.

  • Stretching: Especially the plantar fascia, Achilles tendon, and calf muscles.
  • Shoe inserts: Shock-absorbing insoles, generic arch supports, and custom arch supports all work, but custom arch supports may be better at increasing activity in patients with heel pain.
  • Night splints: Using these with foot orthotics improves the results of both alone.
  • Shoe rotation
  • Therapeutic ultrasound from a physiotherapist
  • Programs supervised by a physiotherapist get better results than self-managed programs that occur after an initial consultation.

What Does Not Work for Heel Pain?

The big thing that does not work for heel pain is letting a healthcare provider tell you to keep waiting. In most cases, people wait until it’s pretty bad before going to a healthcare provider. They have already waited. Research shows that when healthcare providers tell people with heel pain to wait a little longer, results are worse.

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