Are Painful Heels Preventing You From Running?

Plantar Heel Pain (Plantar fasciitis) and Custom Foot Orthoses

Signs and Symptoms

Do you suffer from excruciating pain in the bottom of your heel that has finally put you out of competition? Then you most likely are afflicted with the condition called plantar fasciitis. This condition is characterised by pain that is at its worst whenever you stand usually first thing in the morning or following a short period of rest.

The pain is centralised at the bottom of the heel and typically settles itself down by mid-morning only to recur as a dull ache by the end of the evening. In worsening situations, this cycle of pain usually increases and eventually remains continuous throughout the day. At its peak, the whole plantar fascia can become sore at its origin on the heel bone, along with the body of the fascia and even where it inserts at the base of all the toes.

What’s Going On?

In anatomical and medical terms, there is a fibrous structure that everyone has deep within the arch of the foot called the plantar aponeurosis. This is also known as the plantar fascia and it is attached to the bottom of the heel bone. This structure is made up of one large central band flanked either side with two thinner outer bands extending along the arch and toward the toes. Here the ends of the plantar fascia fan out and attach to the bases of the toes.

When functioning normally this structure will assist in the natural support of the arch of your foot, however, usually, when the arch of the foot is in collapse ( excessive foot pronation), this structure can come under tremendous strain and may become injured by tearing where it anchors to the bottom of your heel.

A common misdiagnosis for this condition is that of a bony spur. Bony heel spurs may protrude from the bottom of the heel into the plantar fascia, however, it is now common podiatric medical practice to recognise that such a bony spur does not have to be present for you to suffer from the above symptoms. In fact, heel spurs can be found in the general population that have no plantar heel pain.

How is it Treated?

Treatment for this condition would involve the taking of non-steroidal anti-inflammatories, and stretch of the Achilles tendon complex. Other modalities such as ultrasound or therapies such as foot and ankle manipulative techniques can be helpful in reducing the symptoms. Steroid injections also have a role to play in the treatment of this condition but in the author’s experience, they really should only be attempted as a last resort if all other means of treatment have not been successful.

Where the symptoms are only partially relieved then it is not unreasonable to consider custom foot orthoses as a method to provide long-term settlement of the condition. Custom foot orthoses will adjust any underlying poor foot posture that causes excessive foot pronation thus taking the stress off the plantar fascia and allowing it to heal.

What are Custom Foot Orthoses?

Custom foot orthoses are prescription medical devices that fit into your normal shoes and are intended to adjust the posture of your foot. The effect of the insert will change how your foot weight-bears and will sometimes alter how your foot strikes the ground. The overall result of these medical devices provides for more comfortable and efficient standing, walking and running that can extend over several years.

Do Foot Orthoses Change The Shape of My Feet?

In theory, there may be some correction achieved in the growing foot, however, should a person stop wearing their devices then their feet revert to their original posture. This is still not a bad deal as eyeglasses are worn on the same principle. Go without the glasses and you do not see, wear them and your eyes work much better.

Who Do I Need to See to Be Examined for and Treated With Foot Orthoses?

Podiatrists are trained specifically in lower limb biomechanics. Their education specializes them in the diagnosis and treatment of all manner of foot conditions. This training encompasses the related systems and structures of the human foot and lower leg including neurological, circulatory, skin and musculoskeletal systems. Chartered Physiotherapists who have a special interest in lower limb biomechanics also are in a position to prescribe custom foot orthoses.

What is Involved to be Assessed for Custom Foot Orthoses?

Should you suffer from persistent pain in your feet and legs associated with prolonged standing or walking then it is best to be seen by a practitioner who specializes in lower limb biomechanics. Initially, your practitioner will take a detailed history of your complaint and may ask for details on your background medical history. They should examine your footwear and may have a look at you standing and walking. Sometimes simple investigations such as padding applied to your feet or simple insoles worn in your shoes for a couple of weeks can indicate the necessity for a more permanent and long lasting pair of foot orthoses. Should your practitioner feel that you are a suitable candidate then they will arrange an appropriate time to perform a more detailed biomechanical examination and gait analysis.

An exam such as this can last up to 1 hour and involves assessing the quality of joint movement of the hips, knees ankles and all major joints within your feet. From such an exam three areas are addressed, these are; Three-dimensional impressions of the feet are taken and sent to the laboratory, tight muscle groups are noted and weak muscle groups are noted.

From this examination, your practitioner will prescribe an appropriate custom foot orthoses suitable for your activities. They should also prescribe appropriate stretching and strengthen routines for certain muscle groups in your lower limbs.

What Happens When I Receive My Custom Foot Orthoses?

An adjustment period is always expected when first wearing custom foot orthoses. Follow all written instructions on care and wearing of your orthoses that always come with such devices. Remember you have been running with your own particular signature for all your life and retraining of this pattern will require some time. Always continue with any prescribed stretching and strengthening programs recommended by your practitioner.

Once I Have Broken Them in What Next?

It is advisable to have a periodic checkup with your practitioner. Over time, with normal wear and tear, your orthoses may require refurbishment. This usually involves going without your devices for a short period when they are sent back to your chosen laboratory. Your practitioner may also want to review how your stretching and strengthening routines are progressing. In general, if you are doing much better then get back to competing.

Mr Scullion is a podiatric surgeon and has been in private practice in The Castleknock Clinic, 23 Castleknock Avenue, Castleknock, Dublin for 23 years. He has also guest lectured over a 10 year period in lower limb biomechanics for the MSc in Sports Medicine at Trinity College, Dublin.

by P. G. Scullion podiatric surgeon