All you need to know about Heel Pain, bone spurs and how to get rid of it!
How can get rid of Heel pain? What is the remedy for heel spurs? What I can do to fix pain under my foot? I've been asked this question more times of the past year than I have in the previous 8 put together. Plantar Fasciitis, or more commonly known as heel pain or heel spur is affecting many people, regardless of their level of physical activity. As I practice in the CBD (orchard road) of Singapore, I see just as many local Singaporeans as well as expats complaining of heel pain.
Three of the most common denominators is the quality of our foot support structure, our footwear support structure and the hard flat surfaces we are constantly on. All of these factors are creating a proprioceptive deficit in our brain - in other words, our foots natural receptiveness and ability to mold, adapt and shock absorb are lost. Our feet is decaying and becoming numb to the constant pounding on the same hard surfaces day in and day out.
This also impacts our weight bearing and weight transfer. Since our feet is the in contact with the ground, it becomes our first base of support. Poor mechanics at the bottom can lead to compensatory distortion patterns throughout the rest of the body, especially in the knees, hips, pelvis, and spine (lower back).
I was in the coffee shop enjoying my kaya toast for breakfast the other day, and heard two aunties chatting about heel pain. One lady was from Singapore, while I believe her friend was from Malaysia. The Singaporean lady was trying to convince her friend to seek treatment for her heel pain, but her friend kept insisting "it's not that bad" and that the pain is only on and off. She repeatedly said that she'll be fine. Half of me was pushing me to go tell her what it would mean if it got worse, while the other part of me bit my tongue.
What's the long term impact of a chronically painful heel? Well, it's not just about heel spurs that grow out from the bone. It's the loss of life. It's the inability to play the sport you've been playing all these years. You realise that every single step is painfully difficult. Holidays are ruined. You tip-toe around, but that eventually causes calf and knee problems, followed by and aching, then painful back. It's draining living with pain.
So here's everything you need to know about Heel pain and how to get rid of it!
Plantar Fasciitis.... What’s that?
It's one of the most common causes of heel pain. The Plantar fascia is a thick band of tissue under your foot that connects your heel bone to your toes. This fascia is a shock-absorber that supports the arches in your foot. Repetitive tension and stress can create small tears in the fascia, irritating it making it inflamed and painful.
What causes it?
The most common causes and risk factors are
- Poor foot support in footwear
- Poor foot mechanics: Over-pronation of the foot (flat foot), or a rigid high arch foot, which leads to abnormal walking and weight-bearing patterns and increased stresses on the muscles and fascia.
- Prolonged standing, walking or running, especially on hard surfaces
- Repetitive impact, especially runners, basketball players, dancers and gymnasts
- Tight calf muscles and Achilles tendon.
What DOESN'T cause it?
The most common misconception is that heel pain is a result of a heel spur - an overgrowth of bone from the heel that 'pokes' us into feeling pain. Although it's true that some people suffering heel pain have bone spurs, you can certainly get heel pain without having a spur. Furthermore many people who have bone spurs on their heels have no heel pain. The growth of a heel spur may indicate that strain, tears and inflammation to the plantar fascia has been present for a long time. While some may get relief from surgery to remove the heel spur (more on that later), I've personally seen some of my clients who had surgery, and still have the heel pain. Even worse is that for some, the spur grew right back!
What’s it feel like?
- A sharp stabbing pain in the bottom of your foot near the heel.
- Usually worst with the first few steps in the morning.
- Can be triggered by long periods of standing or getting up from a seated position.
- If severe, the pain persists and doesn't ease after the first few steps.
Do I have it? Test yourself.
Does your heel hurt on the first few steps of the morning when you get out of bed?
Is the heel tender to touch using thumb pressure?
Does running, or walking cause you pain?
- Do your feet over-pronate? Stand up a look at the medial (inner side) of the ankle. Does it seem to bulge inwards as you bear weight on it?
Bad news, it could be plantar fasciitis. Good news: you're catching it early, before it worsens and becomes difficult to resolve. Some times, all you need is rest, and the pain resolves itself. If the pain does not resolve itself within 4-6 weeks, seek your chiropractors’ opinion.
2, 3 or 4 YES's:
Highly likely to be plantar fasciitis. Seek your sports chiropractor’s expertise to rule out other possible diagnosis like arthritis or tarsal tunnel syndrome. A great sports chiropractor will also check your feet stability and function, as well as your hip and spine. You can choose to ignore the pain, but your lifestyle will be negatively affected. Chronic heel pain will hinder your day-to-day activities. Walking to the toilet will be a painful experience. And you'll likely develop knee, hip or back problems as you compensate. Click here to get it fixed now!
Dr Gary’s Treatment Protocol
- Use cold compress (Ice pack) - 10 minutes on, 10 minutes off. Repeat 3 times.
- Massage the calf, achilles tendon and sole of your foot. You can use your hands, a foam roller, trigger point ball, or golf ball (for the sole of the foot). Don't over do the sole of the foot, and do not press on the heel (bone).
- Rest. You should stop running (sports) completely or at least decrease your training. This is dependant on the severity and duration of the pain. And seek help immediately to properly diagnose the injury. Cross-training is a great way to stay fit, while you let your heel heal. Remember if it feels like it’s making the pain worse, stop doing it.
- Stretch your calf and achillies tendon by standing about two feet away from a wall. Place the ball of your foot against the wall while your heel remains on the ground. Slowly and gently lean into the wall while keeping your knee straight. Hold 30 seconds, release and repeat on the other side.
- Stretch your plantar fascia: Kneel on a mat, legs and feet together and tuck your toes down so they are pointing forward. Then slowly sit back onto your heels. Try to get your buttock on your heels, or until you feel tension on the sole of your foot. Hold for 30 seconds, release and repeat.
Dr Gary’s help
- If you've tried the DIY approach, or other forms of treatment and therapy without success check if it involved all of these steps. Here's what did for my aunty, and what I do with all of my clients.
- Initially a clinical examination is performed to properly assess the lower leg and foot as well as any compensatory changes that have resulted higher in the knee, hip, pelvis and spine. I will also need to differentiate the different causes of heel pain. We also use a 3D foot scanning device that allows us to see a 3D image of your foot, and calculate the amount of support of your feet. Some people require X-rays or bone scans to see if stress fractures (and heel spurs) are suspected.
- Chiropractic treatment would involve identifying and treating mechanical issues in your feet, ankle and legs. This includes correcting the alignment and movement of the individual joints within the ankle and foot, releasing the tension and compression of muscles, tendons, fascia that have been pulling hard and overstrained.
- Improving the lower body mechanics - to ensure all muscles, tendons, joints and ligaments from the spine to the hip, knee, ankle and foot work together efficiently and effectively. Poor teamwork results in excessive stress placed on certain ‘weak’ points, resulting in injury and pain.
- Sports taping with rigid tape is effective to relieve strain and provide some support to the plantar fascia. We can also use kinesiotape to facilitate circulation, muscle recovery and decrease inflammation and muscle strain.
- Ultrasound therapy to ease the pain, reduce inflammation, improve circulation and break up scarred tissue to enhance the repair and remodelling process of the healing cycle.
- Rehabilitation includes stretching, mobilisation and strengthening exercises. These may be chain movements for the entire leg, or specifically for the sole of the foot, calf, or shin. Advise and correction of running techniques, like shortening your running stride will also help encourage better stride mechanics.
- Those with flat feet (over-pronated feet) may need orthotics (insoles for shoes). The made-to-measure orthotics we use, are 100% customised, unlike many that are an off the shelf product, that is heat molded to fit you. These insoles, can be made to fit a variety of shoes from leather dress shoes and ladies flats to sports shoes, military work boots and even high heels. The other huge difference between our orthotics is that they are flexible, stimulate (the nerves in) your feet, while providing comfortable cushioning. This is hugely different to rigid orthotics that acts as a brace, preventing any natural movement of the foot and not providing any basis of shock absorption.
- Prescribed medication including pain killers, anti-inflammatories and muscle relaxants are commonly used. They are great for initial short term relief. Prolonged use would not be suggested as chronic pain means the root cause of the problem is not addressed.
- Some opt for a steroid injection. It's a potent anti-inflammatory that's injected directly into the irritated muscles and can give immediate and amazing relief. Just remember that if you choose this option, the healing and recovery is not done. (You still need to relieve the strain on the injured tissues, and get them to repair, recover and strengthen or the pain will just come back!) Also, multiple injections aren't recommended because they can weaken your plantar fascia (may result in rupture) as well as other soft tissues around the are from blood vessels and other ligaments. It can also shrink the fat pad covering your heel bone.
- My aunty chose this route, as the wanted something fast and easy (no effort involved here!). She felt great for almost a year! BUT the pain came back again, as bad as ever. It was only when it came back that she realised it only covered up, but never fixed the problem.
- If there was a heel spur found on x-ray some people opt for surgical intervention. It is not common nowadays and I would only think about suggesting it if the pain is severe and all else fails. The surgery may also weaken your foot's arches.
Caution: You may feel great because pain-relieving medications cut off pain sensations. However if you start doing activities that initially caused the pain, you will make the injury worse but you won’t feel it, because the drugs numb the pain.
So there you have it, the full and remarkable solution to get rid of heel pain! Drop me a note if these suggestions have worked for you!! I'd love to hear of your relief. You can also make an appointment to see me and end your tip-toeing, sport-avoiding days!