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The Treatment of Plantar Heel Pain

The Treatment of Plantar Heel Pain

Plantar Heel Pain or as it is more commonly referred to, Plantar Fasciitis, is a condition of the long ligament underneath the arch of the foot. It often presents as pain in the heel in the morning and after being put under significant stress.

Due to the functional significance of the foot in activities such as standing and walking, it makes it difficult to reduce this load and offload this fascia in comparison to other tissues in the body.

This means heel pain can often become chronic and long term. Treatment ideally would look to reduce these risk factors causing the problem and improve the fascia’s capacity to withstand stress. However, treatment is not often that easy and health professionals often need to look at alternative ways to offload, recover and improve the plantar fascia resilience and ability to tolerate the stress it has put on it.

The four main treatment groups are classified as:

Load Modification:

This treatment aim is to reduce to load placed on the fascia and will help the healing process and ensure pain is reduced. Whilst this does not reduce any risk factors it does look at reducing the stress on the tissue and often has the best impact upon a person’s return to function. These treatments include, but are not limited to:

1. Low Die Taping
2. Orthotic Therapy
3. Footwear Changes

Strengthening:

Another key element to treatment is improve not only the capacity of the fascia to tolerate the stress that goes through it on a day to day basis, but improve the strength and capacity of the fascia. The other key aspect is to improve the strength and endurance of the other muscles in the foot and lower limb so consequentially the fascia does not have to take as much load.

This can be through:

1. Modifying activities to allow the tissue to adapt, then slowly increase it.
2. Strengthening exercises for foot and calf complex (i.e. calf raises).
3. Strengthening exercises for muscles surrounding the hip & knee.

Soft Tissue Modification:

These treatments are aimed to improve the tightness and length of tissue surrounding the foot and ankle. Often when motion is restricted from structures it changes loading patterns within the foot. By performing treatments such as:

1. Plantar Fascia Stretch (image)
2. Spikey Ball & Foam Rolling
3. Dry Needling

These techniques can all assist in pain relief, and improve joint ranges of motion that in turn may reduce the load on the fascia.

Enhance The Inflammatory/Healing Process:

This list is long, and often these treatments lack strong scientific evidence. We at SESP grouped these under one sub-heading however they all have varied mechanisms of action to fix your heel pain. In summary these treatment methods look to improve the healing and inflammatory process involved in the condition, with the assumption that healing the fascia will reduce pain and allow for the individual to reduce their risk factors without pain. These treatments include:

1. Ice Bottle foot roll out
2. Shock Wave Therapy
3. Corticosteroid Injection
4. Platelet Rich Plasma Injection

There are a range of different treatments we can use to treat Heel Pain. We work with you to modify and direct your treatment protocol to ensure the best outcome.