With the beautiful Wisconsin Fall whether upon us, this is a great time of the year to get outside for some long walks and runs. Also, there are some great running events coming up (The Fall 50, Women’s Half Marathon) that some of you will be participating in. As you are on your feet more walking or training for these running events, it is not uncommon to experience some pain in one of both of your heels. It has been reported that 1 in 10 people will experience plantar heel pain, also know as plantar fasciitis, and this number is likely higher for people who regularly walk or run for exercise and/or stand on their feet a lot at work. This pain can be quite debilitating and have a significant negative impact on a person’s ability to be on their feet and enjoy walking and running for exercise.
Plantar fasciitis is pain that occurs on the bottom of the foot and usually to the inside of the heel. People will feel it most commonly during the first few steps when getting up in the morning, getting up after prolonged sitting, or at the beginning of a work out. The pain pattern lessens during a day of regular activity, but increases as the activity intensifies and may linger after the increased intensity has ceased. Rest sometimes helps but for many people who are training for an event, just want to stay active, or just need to work on their feet, this is not the best option. So, what helps?
Treatment approaches of plantar heel pain are many. Sometimes a corticosteroid injection is recommended, but this has been shown to be ineffective and has the potential of serious side effects, including rupture of the plantar fascia. More commonly, treatments include ultrasound, iontophoresis (administration of medication with electrical current), icing, and stretching, although the evidence is limited for these treatments in the long term as well. Is there something better?
In 2009, Josh Cleland and colleagues performed a study to determine if a treatment program consisting of manual physical therapy interventions and exercise was more effective than an electrophysical modalities and exercise approach (ultrasound, iontophoresis, icing, and stretching) in patients referred to physical therapy for plantar heel pain. The electrophysical modality approach is what is commonly done for this type pain in most therapy clinics.
The conclusion from their study was that a treatment approach consisting of manual therapy to the foot, ankle, knee, hip, and calf musculature combined with home self treatment exercises was more effective than the ultrasound, icing, stretching, and iontophoresis at both 4 week and 6 month follow ups. This is significant as it allowed people to get back to doing the things they enjoyed without being limited by heel pain quicker and without the pain returning at 6 months.
Manual therapy in this study consisted of hands-on treatment to a variety of regions in the lower extremity. Through a detailed examination of the individual patients enrolled in the study, therapists chose manual therapy techniques that were expected to benefit the patient. The examination looked at regions of the hip and knee and not just the foot and ankle. The key here is the detailed examination-receiving a comprehensive examination of the entire lower extremity-something not often done by all physical therapists. When treating any region because of a pain complaint, a good therapist will consider and evaluate other regions that can contribute to the current symptoms. Without this, you may not be obtaining all of the treatment that is needed to not only make you better in the short term but more importantly, allows you to function pain free in the long-term.
If you are struggling with heel pain (plantar fasciitis), know that there are treatments that can be done to help you get back to walking or running pain free. If you have already received treatment that did not help and it consisted mainly of ultrasound or iontophoresis with some stretching, you have not received all of the treatment that can help you. You will likely benefit from a more comprehensive evaluation and treatment plan consisting of manual therapy and more specific exercises to promote a more lasting resolution of your symptoms.
If you have questions about what can be done to help with your heel pain, feel free to contact me at
Thanks for reading,