by Dr. Troy Vander Molen, PT, DPT
If you’ve every woken up and experienced pain in the heel or arch with the first steps of the day, you are far from alone. Around 10% of the US population experiences episodes of heel pain, often caused by something called plantar fasciitis, and this painful condition has also been experienced by elite athletes like Kobe Bryant, Eli Manning, and Albert Pujols, as well as former presidential candidate Mitt Romney.
Plantar fasciitis… That’s a mouthful, I know, and it’s difficult to spell. So let’s agree to simply call it heel and arch pain. That medical term – plantar fasciitis – was penned because the condition was historically thought to be an inflammation (“-itis”) of the connective tissue (“fascia”) on the underside (plantar surface) of the foot. That tissue extends from the heel bone to the toes, but the most common area of irritation is at its connection at the heel.
The designation of the condition as an inflammation, though, is often inaccurate. Yes, it’s possible to experience inflammation of this tissue, which would most often occur after a sudden, traumatic injury to the foot. More often though, it is a recurrent, chronic condition that doesn’t involve inflammation at all. Much like tennis elbow or pain in your Achilles tendon, with repeated stress the tissue degenerates. This results in a weaker tissue that is less capable of handling tension stresses, and the tissue over time requires less stress to elicit pain.
So, now that we’ve discussed the most common cause for heal and arch pain, let’s discuss practical information that can help you conquer this condition.
What are the most important things for you to know if you deal with recurrent heel and arch pain?
The best way to deal with heel and arch pain is to prevent it from occurring in the first place. Perform stretches to maintain flexibility as you age in the feet, ankles, knees and hips. Consult with a physical therapist to learn what activities are the best for you, based on your most significant flexibility issues.
Wearing shoes that match your specific foot needs is important as well. Many people benefit from the correct shoe match with their foot, and some may need additional support at the arches.
Traditional treatments focus on reducing or eliminating the inflammation. Cortisone injections, ultrasounds, and anti-inflammatory medications (steroids and non-steroidal) all attempt to manage inflammation. However, unless you have a new heel and arch pain condition that began from a single traumatic event (which causes acute inflammation), these types of treatments are unlikely to help you. While they might reduce the pain temporarily, your pain will return and the treatment investment will not yield the results you need if your condition is degenerative – and most are.
The root of the problem is that the tissue is weak and cannot handle tension stresses, which are significant when you load the foot while walking. Treatments that enhance tissue density through a remodeling effect are much more likely to impact the root of the problem.
Physical therapists at Kinetic Edge, for example, are trained in instrumented-assisted soft tissue mobilization like Astym (www.astym.com) which helps tissues regenerate. Astym is great for heel and arch pain, elbow pain, and Achilles tendon issues, to name a few.
To read more about this approach, check out this link about some friends of our practice in Tennessee that use the Astym approach.
The tissues at the heel and arch are the proverbial weak link that degenerates over time. This degeneration occurs because those tissues repeatedly accept more physical stress than they should, and that’s often the fault of neighboring joints and muscles. While using Astym treatments to help the tissues remodel and regenerate is essential, enhancing the movement of the entire kinetic chain is also critical to prevent this painful condition from reoccurring.
A physical therapist helps you identify important movement skills for you to balance the physical stressors on your legs so that all tissues work together to accomplish the important task of bearing weight so that you can walk, run, jump, and dance comfortably again.
If you’d like to learn more about your body and why you might be experiencing heel and arch pain, email us to get scheduled for a free assessment with one of our physical therapy movement experts. This free assessment has no costs or obligations and requires only 20 minutes of your time.
Your feet just might thank you.