Heel Pain – the two most common conditions

Plantar Fasciitis or Heel Pad Syndrome?

Heel pain is very common this time of year….we are into race season and sandal season and flip flop season (that’s a whole other topic) and barefoot season…..all of which can change the tension on the tissues in the foot (and the rest of the body).

Heel pain can be debilitating. If can affect our day to day life and our training/racing schedule. Treatment for heel pain is determined on the proper diagnosis. Here I will elaborate on the two most common causes of heel pain in my clinic, Plantar Fasciitis and Heel Pad Syndrome.

Typically, Plantar Fasciitis (PF) will present with sharp pain in the heel during the first few steps in the morning or after sitting for a prolonged period. Pain may cease after  the tissues are warmed up (when walking or running). However, after a prolonged period of standing or activity the pain may worsen. 

Heel Pad Syndrome (HPS) presents as a deep ache in the middle of the heel. It may feel bruised. Our heel pad is ~1inch thick and it protects our heel bone from the ground. This pad can sometimes spread out and thin out instead of staying thick and squishy.  Walking barefoot or walking on hard surfaces like hardwood or ceramic tile will aggravate the pain.

Treatment is different for each condition.

Treatment for HPS is simple but it’s not what people want to hear (especially athletes); lots of cushioning and stay off your feet. “Stay off my feet?!” is a common response I hear. But yes, staying off the foot, to allow the heel pad to heal is important. Cushioning can take different forms. Taping the heel is one of the best ways however re-taping every day or two can be time consuming. Taping allows the heel pad to be stabilized and as I tell my patients “It makes it thick and squishy….a nice pillow for your heel bone”. Shoes with lots of cushion is also recommended and/or a gel pad in your current shoes. Comfort and cushion is the key!

PF treatment varies upon the individual. For some, manual treatment (ie: ART®) combined with sleeping with a Strassburg Sock or a hard foot splint (to keep the PF lengthened while sleeping) helps. For others, orthotics are the key. Other suggestions I give to my patients include; Foam Rolling, taping, changing shoes, change training habits, etc. If you are a runner, then running form and cadence is also analysed. This is all on an individual case by case basis. After 6 weeks of conservative religious treatment, if an individual has not responded or has responded with only minimal improvement, then other therapies like shockwave can be considered. 

I often see HPS and PF at the same time. This can get tricky. HPS must be treated and cleared up first. This is patient dependent and tends to take longer to heal.

All of this being said there are still other issues going on in a body that can contribute to the overall health and recovery of lower limb injuries like PF and HPS. Pelvic dysfunction must be looked at as well. Proper force transfer, sufficient strength and equal balance side to side is essential for the recovery and prevention of lower limb injuries like Plantar Fasciitis and Heel Pad Syndrome.

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