Heel Pain Solutions
Plantar Fasciitis or Fasciopathy
The Functional Approach
If you’re experiencing pain on the bottom of your heel, worse with the first few steps in the morning out of bed or getting out of a chair, it could be plantar fasciitis. Inflammation of the fibrous tissue called the plantar fascia could be from overuse, poor shoes, weak foot muscles, or a combination of the above.
Heel pain that doesn’t resolve with conservative measures needs a deeper dive into what else is going on. Here is everything you need to know about treating plantar fasciitis from a functional podiatrist’s perspective.
Sections
The most common reason for plantar fasciitis & home care
Do you need orthotics?
Medical & surgical treatments
Overuse or Disuse
Many jobs require long periods on our feet without breaks. This includes nurses, doctors, teachers, police officers, mail carriers, house cleaners, farm workers, retail workers, and so many others.
If you’re experiencing heel pain, take periods of intentional rest. For every hour, take a 5 minute break off your feet. Some people may be able to condition their feet to be on it longer, take time to build up the tolerance for longer periods.
For those who went through a period of disuse or decreased activity, be mindful about jumping into an activity. There were a lot of folks suffering from heel pain right after the pandemic, resuming their usual high level activity without conditioning their feet. So ease into activities and take breaks when your feet start to hurt.
Improper Shoes
If you find that your feet still hurting, it might be your shoes. Shoes have a wear time before the inner cushion degrades. It is recommended to get new shoes after 3000-5000 miles or every 6 months if you were the same pair consistently.
Look for shoes with good arch support, a durable cushion, and that it has room for all of your toes. See Dr. Tea’s footwear recommendations here.
Rotate through different shoes to make them last longer.
Test your shoes before venturing to a long-term activity to prevent further pain and injury.
Weak Foot Muscles
You might be wondering about the barefoot movement. As a functional podiatrist, there is value to minimalist or barefoot-style shoes but you need to condition your feet to have a lasting impact that does not lead to more injury.
Whether you like conventional shoes or barefoot style shoes, everyone can benefit with strengthening their foot muscles. Weak foot muscles lead to strain and imbalance. For longterm foot health, you can easily incorporate the following exercises to your daily routine.
Perform these daily:
Short Foot Strengthening - focusing on the foot as a tripod, this exercise helps strengthen the medial arch targeting the abductor muscle. Learn more here.
Flexor Digitorum Brevis Activation - these fibers are connected to the plantar fascia and extend to all 5 toes, bringing them downwards. You can use a band to move the toe against resistance one toe at a time as you develop the brain-muscle connection. The challenge is moving each toe by itself!
Hallux Toe Taps - another way to isolate the big toe is to raise all 5 toes and focus on only tapping the big toe on the ground.
Double Heel Rise - this focuses on the posterior tibial tendon that connects the arch to the leg muscle. Standing on both feet on the ground, knee slightly bent, and raise both heels off the ground. You can use a tennis ball and keep it between the heels as you rise up. You can hold on to something for balance. When comfortable, you can transition to a single-leg heel rise to challenge yourself. Make sure your leg stays in line with your foot, rather than knocking your ankles out which can cause injury.
Toe Separators - At the end of the day you want to maintain flexibility in your toes by either manually stretching them out (imaging interlacing your fingers between your toes) or using a soft silicone toe spacer (Yoga Toes or the like) wearing them 15 minutes a day and walking around barefoot in the house to activate the intrinsic foot muscles. The goal is to maintain mobility and flexibility so you can have better balance on your feet.
Strengthening your feet will reduce foot pain and injury.
Do You Need Orthotics?
Orthotics are medical devices placed inside your shoes to support your feet. They are analogous to prescription glasses for the eyes.
These are often confused for inserts sold at retail stores that do not offer arch support but rather are simply cushions. The reason orthotics are superior for people with foot pain is that they restore foot balance and limit pronation, thus decreasing soft tissue strain and pain.
For some, orthotics are a temporary solution until foot pain is resolved and they are motivated to strengthen their foot muscles for longer-lasting results. For others who are looking to avoid surgery or have complex deformities, they may need to wear custom orthotics indefinitely.
Dr. Tea can help sort out the confusion with a personalized assessment and treatment plan.
Nonsurgical Treatments
Addressing external stressors, proper shoes, and foot muscle conditioning are the core treatments for plantar fasciitis
When home care does not provide adequate results, Dr. Tea can provide additional solutions including
Prescribing custom orthotics
Offer steroid injections or prescriptions for immediate pain relief
Natural treatments to induce self-healing such as nonsteroidal injections, shockwave therapy, or laser therapy
Optimizing your health with diet and supplement recommendations
Order additional labs and tests to understand why your symptoms have not resolved
Surgical Treatments
Plantar fascia releases are becoming an outdated procedure due to more recent innovative options with functional podiatric medicine
It is important to discuss and weigh the risks and benefits with your surgeon
If surgery is recommended, minimally invasive options are available that offer less downtime, less scarring, and pain resolution
Your health is an investment.
Let’s talk.