Different terms for heel pain
There are a few different terms for pain around your inner heel. For example, you might have heard it called runners’ heel.
Another common name for inner heel pain is plantar fasciitis. The plantar fascia is a long ligament that runs along the bottom of your foot. The name ‘plantar fasciitis’ literally means ‘inflammation in the plantar fascia’.
But researchers have found that the cause of the pain is not usually inflammation. So as physiotherapists, we prefer the term plantar heel pain. This covers the wide range of conditions that could be causing the problem. For example, the breakdown of collagen (a protein found in bones, skin and muscles) in the plantar fascia.
Signs of plantar heel pain
The classic location of plantar heel pain is right under your heel. It can also be towards the inner side of the heel. The condition is usually easy to diagnose because the pain is in such a particular place. If you've got pain that feels like it has spread to other areas, like your toes or the back of your heel, then there may be another condition causing it.
People usually say the pain is at its worst in the morning when they first step out of bed. The first few steps of the day are normally very painful, and you may find yourself limping.
Difficulty walking downstairs in the morning can be a sign of plantar heel pain. Some people also say that it's painful to stand up. If you've been sitting down for a little while and then you stand up and try to walk, you might find that you’re hobbling.
Who gets plantar heel pain?
As physiotherapists, we see two main types of people affected by plantar heel pain. The first group are very active people who perhaps do lots of running or long walks. The second group are people who don’t regularly exercise. For these people, the pain may start after a change in their activity levels. For example, if somebody who works a sedentary job decides to do a long hike or start running.
Plantar heel pain can also happen to regular runners when they change their routine. For example, if they have new footwear or are running on a different type of ground.
People can also be more at risk after gaining weight. Tight calf muscles, and instability around your ankle and foot muscles, can contribute too.
How is plantar heel pain treated?
When we see people with plantar heel pain, the first thing we do is try to reduce pain, swelling and irritability. We may recommend silicone heel cups. You can buy these from pharmacies. They contain gel to relieve the pressure on your heel. We may also recommend a change of footwear.
Insoles can sometimes help, but research hasn’t found them to be particularly effective for heel problems in the long term. There are also some techniques for using tape around your heel, that may help in the short term too.
After these initial measures, we’ll look at how you can rehabilitate the plantar fascia through exercises over time. Patients who follow these recommended exercises routines usually recover the quickest.
These exercises aren’t only focused on your heel. Research has found that doing plantar fascia stretches combined with calf stretches is more helpful. Physiotherapists can also recommend exercises to improve your stability higher up your body, for example in your hips.
How can you prevent plantar heel pain?
Keeping to a healthy weight can help prevent plantar heel pain. Your GP can give you guidance about the best way to do this.
You can also think about what we call your ‘load capacity’: how strong and stable your heels are. How much daily walking are you doing? How much running are you doing? How much standing are you doing? Is there something that we can change? If you're looking to increase how active you are, be mindful to do that very gradually. Don't go from zero to 100 within the space of a few days!
General strength and conditioning exercises can really help, particularly lower limb strengthening exercises. These can include calf, quad, hamstring and glute exercises. These exercises can prevent a huge range of injuries, particularly if you run often. Having strong, conditioned lower limbs prevents a lot of the running problems that we see as physiotherapists.
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