People often associate heel pain with plantar fasciitis, but not all heel pain is plantar fasciitis. Plantar fasciitis might not even be a thing!
There can be a number of reasons for heel pain:
- Plantar fasciitis??
- Trigger points in the quadratus plantae, soleus, gastrocnemius, or tibialis posterior
- Fat pad syndrome
- Tightness in the gastrocnemius and Achilles tendon can create a tight plantar fascia
- Disc herniation (yes, it can come from your back)
Either way, heel pain sucks! Especially if you’re a runner.
Classically, plantar fasciitis is characterized by a stabbing-type feeling first thing in the morning when trying to walk after waking up and there is point tenderness over the medial aspect of the calcaneus.
Most often people will get cortisone injections into the plantar fascia to relieve the symptoms. However, this is a short-term fix and the plantar fascia is actually weakened by the steroid injection.
A thorough examination can get to the bottom of why you’re having heel pain, instead of just masking the symptoms. If the ultimate goal is to alleviate the pain so that you can get back to running, hiking, or whatever it is that you’re missing out on, shouldn’t you find out what’s really leading to the heel pain and fix it.
The human body is amazing at compensation. When something is hurt or doesn’t feel right the brain will take the path of least resistance and find a way to perform the same task in a different way. The problem is that these compensation strategies can stay long after the pain is gone. Once these compensation patterns are engrained in our movement patterns, we start to overload certain areas of the body. That overload leads to microtrauma, and eventually macrotrauma.
A common issue with “plantar fasciitis” is the inability to properly control the foot through the gait cycle (or running). Often times you see people will overload one aspect of the foot (medial arch) and have no FEEL for the lateral arch. However, its difficult to pinpoint what is causing this lack of control at the foot...is it the muscles in the leg? Is it the hip? Is it an old low back injury? Is it running form, cadance, or stride length? Running shoes?
The answer is not simple. It could be all of the above that need to be addressed. You may need to learn how to properly stabilize your foot and hip. Or learn how to create sufficient intra-abdominal pressure while running. Or change your running form or shoes.
The treatment of plantar fasciitis should be geared towards returning the foot to a position where everything is balance and there is no overload of tissues. To allow for the foot to dissipate forces properly and in doing so relax the plantar fascia and surrounding musculature. And also, looking at the entire locomotor system to find the key link in resolving the issue.