Background of Planter "Heel Pain"
Heel pain is a common presentation that affects people across the lifespan from athletes to
individuals who are more sedentary, it affects 4-7% of the general population and accounts
for 8% of running injuries (1, 2) . This pain can have a large impact on sports performance
and quality of life. We know this can be horrible and something we want to help you change ASAP!
Most pain we experience at our heel arises from one of three soft tissues: Tendons fascia or
nerves. Sources of bony pain at the heal while can occur are less common. So, Lets break
down the more common causes heel pain…
What are the Causes?
Tendon
Tendons connect our muscles to our bones, and function as springs that transmit the force
generated by our muscles through to our bones to create movement. Tendons can be
commonly involved in planter heel pain are the tibialis posterior tendon, flexor hallucis
longus and the Achilles (calcaneal) tendon.
Tendons can be aggravated by changes in compressive loading (this can be external such as
shoes, or internal such as being compressed on around a bone) or tensile loading (such as
increases running or walking).
Fascia
The planter fascia is another common cause of planter heel pain. The planter fascia is very
similar to a tendon in the way it responds to load, and its structure. A planter faciopathy,
presents with pain at the attachment site of the plantar fascia, with pain with the first few
steps after rest, that warms up with exercise but is normally sore after a long day on your
feet or a training session.
Neural
Potential neural causes include baxters (inferior calcaneal) nerve entrapment, Medial
calcaneal nerve entrapment, tarsal tunnel
syndrome. These conditions lead to a burning
sensation in the foot other than tarsal tunnel
syndrome which causes numbness in the
bottom of the foot.
Could it be a bursa?
While a bursa may be inflamed the bursa is rarely affected in isolation therefore the
condition while may be aggravated by bursa involvement should be treated as a
tendinopathy.
Other
Other possible causes of planter heel pain are severing disease (occurs in adolescence),
calcaneal stress fracture. Don't worry if this sounds scary, it is our job to work with you and your podiatry team to work out what is going on and establish a plan together. We are lucky @movesportsphysio we get to work alongside the team at Profeet and Performance Podatry
What can I do about it?
At MOVE Sports Physio we will assess your foot, and lower limb and complete a thorough assessment, once we with you on a diagnosis we will give you a plan to move forward.
Treatments vary depending on the cause and your individual circumstance but potential
treatment options include;
Taping
Multiple studies have shown low dye taping to be an effective treatment for reducing pain
for people with plantar heel pain (3) . This taping can be done at home to reduce pain;
however, taping does not address the root cause of plantar heel pain and needs to be
couple with exercise.
Off the shelf orthotics
Either prescription or off the shelf orthotics can help reduce pain in plantar heel pain
(4) ,look for an orthotic with medial arch support.
Strength training
High load strength training has been shown to significantly improve outcomes (5) for people
with plantar heel pain. The exercises very depending on the specific cause of your heel pain
and stage of recovery exercises can include:
Calf raises with big toe in dorsiflexion.
Calf raises with ball in-between legs.
Stair walking progressing running with ankle control and no heel drop.
Foot muscle strength training
A link has been found in reduced intrinsic foot muscle strength and development of painful
foot pathologies, while these the benefits of these exercises need to be investigated further
peer peer-reviewed journals, clinical experiences tell us that these exercises can be beneficial for
a range of conditions around the foot and ankle. These exercises can include;
Big toe plantarflexion
Towel scrunches
Toe waving
So if you have heel pain get try these exercises or get in touch so we can work with you to help you get moving and pain free again!
Get in touch with the team at Move if you would like to learn more or have specific questions related to your heel pain.
We love staying up to date with the latest research at MOVE. See below for the articles we used to create this article.
Written by Joseph Smith - to find out more about Joseph or to work with him in clinic book here
1. Hill CL, Gill TK, Menz HB, Taylor AW. Prevalence and correlates of foot pain in a
population-based study: the North West Adelaide health study. J Foot Ankle Res.
2008;1(1):2.
2. Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A
retrospective case-control analysis of 2002 running injuries. Br J Sports Med. 2002;36(2):95-
101.
3. Kim DH, Lee Y. Effect of Dynamic Taping versus Kinesiology Taping on Pain, Foot
Function, Balance, and Foot Pressure in 3 Groups of Plantar Fasciitis Patients: A Randomized
Clinical Study. Med Sci Monit. 2023;29:e941043.
4. Whittaker GA, Munteanu SE, Menz HB, Tan JM, Rabusin CL, Landorf KB. Foot
orthoses for plantar heel pain: a systematic review and meta-analysis. Br J Sports Med.
2018;52(5):322-8.
5. Rathleff MS, Mølgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, et al.
High-load strength training improves outcome in patients with plantar fasciitis: A
randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports.
2015;25(3):e292-300.
6. Osborne JWA, Menz HB, Whittaker GA, Landorf KB. Development of a foot and ankle
strengthening program for the treatment of plantar heel pain: a Delphi consensus study.
Journal of Foot and Ankle Research. 2023;16(1):67.