This is a summary excerpt of the 2014 clinical practice guidelines for heel pain (plantar fasciitis)
1) (Moderate Evidence): Limited ankle dorsiflexion range of motion, high body mass index, running, and work-related weight-bearing activities with poor shock absorption are risk factors for heel pain/plantar fasciitis
2) (Strong Evidence): Clinicians should use manual therapy, consisting of joint and soft tissue mobilization, procedures to treat relevant lower extremity joint mobility and calf flexibility deficits and to decrease pain and improve function in individuals with heel pain/plantar fasciitis.
3) (Strong Evidence): Clinicians should use plantar fascia-specific and gastrocnemius/soleus stretching to provide short-term (1 week to 4 months) pain relief for individuals with heel pain/plantar fasciitis.
4) (Strong Evidence): Clinicians should use anti pronation taping for immediate (up to 3 weeks) pain reduction and improved function for individuals with heel painptlantar fasciitis.
5) (Strong Evidence): Clinicians should use foot orthoses, either prefabricated or custom fabricated/fitted, to support the medial longitudinal arch and cushion the heel in individuals with heel pain/plantar fasciitis to reduce pain and improve function for short-(2 weeks) to long-term (1 year) periods, especially in those individuals who respond positively to anti pronation taping techniques.
6) (Strong Evidence): Clinicians should prescribe a 1- to 3-month program of night splints for individuals with heel pain/plantar fasciitis who consistently have pain with the first step in the morning
7) (Weak Evidence): Clinicians may prescribe a rocker-bottom shoe construction in con junction with a foot orthosis
Clinical Pearls: It has been frequently observed in an outpatient setting that those who show signs of heel pain, plantar fasciitis, or stress reaction at the medial calcanea tuberosity also present with abducted, pronated, and/or hallux valgus alignments of the foot. The foot is structurally more stable when the three arches of the foot are at their highest, also known as the supinated foot. The pronated foot is less efficient in absorbing the impact, for example, during the stance phase of gait, because the foot has already exhausted its structural potential to absorb energy from the impact. Therefore, the structures that normally prevent the foot from being overly pronated, for example, the plantar fascia along with other intrinsic muscles and ligaments within the foot will have to suffer from a combination of tensile stress and compression stress and eventually become a pain generator. It is therefore paramount to assess and restore the foot's ability to freely maintain and change from supination to pronation when treating heel pain, provided there are no other extrinsic factors to consider. It is also important to note that other common injuries above the level of the foot/ankle complex such as ACL injury, anteromedial rotatory instability, hip impingement syndrome, piriformis syndrome, ipsilateral low back pain can potentially communicate with development/aggravation of the pronated foot by shifting the body weight and rotating the pelvis to the contralateral side and interrupts our ability to stride forward with the opposite leg. In such cases, we have to look and treat the proximal body parts; otherwise, our effort to treat a client's heel pain will be futile.
I hope this information is helpful to you. The body of literature strongly emphasizes the importance of proper rehabilitation to address heel pain. If you are suffering from heel pain and are seeking for treatment, please contact us or your local physical therapists.
Please comment below for any questions.
References
1. Martin RL, Davenport TE, Reischl SF, et al. Heel pain-plantar fasciitis: revision 2014. J Orthop Sports Phys Ther. 2014;44(11):A1-33.
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