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Self Treatment of Heel Pain

By Brad Perry

Here are a few secrets to avoiding ever seeing me. I’m a PT – a physical terrorist… I mean, physical therapist. Revealing the following secrets may offend some PTs because it might hinder their business. But in today’s economy, those co-pays add up and a few tips wouldn’t hurt. As a physical therapist, my job is to promote healing by providing the optimal healing environment. So here are some simple tips to rid heel pain in triathletes or runners.

heelPlantar Fasciitis, or heel pain, occurs frequently in distance runners and triathletes, but if caught early enough, it can dissipate quickly. Heel pain can be caused by a multitude of different mechanisms. For example, overuse, underuse, or even a difference in your training plan can disturb the tissues. A change in biomechanics, such as a change in footwear, weight increase or decrease, and even a change in your running form can irritate the plantar fascia.

If you have a classic case of plantar fasciitis, your heel will be most tender when you step out of bed in the morning. The bottom of the foot at the heel will be tender to the touch. If the tenderness is bigger than the touch of your index finger or is tender to anywhere else in your foot, go see your podiatrist or other physician. Otherwise, you can proceed with self treatment.

Is your calf tight? Stand erect and barefoot on a hard, flat surface. Can you lift your forefoot from the ground easily without shifting your weight backwards? With enough clearance to slide a “hot wheel” under your foot (the hot wheel came from my 4 year old son — those mini-cars are about 2 inches or 5cm). Or, is the movement in your foot equal to the other foot? If you can’t, or the range of motion in not equal, then a good stretching routine may help you. It is common to have calf tightness as the Achilles attaches to the same bone the plantar fascia does.

Stretch your calf with two exercises: place your forefoot on something that is sturdy and at least 2 inches (5cm) thick keeping your knee straight. Then lean forward and hold this pose for 30 seconds and perform three times. You should feel the stretch behind your knee and lower leg. The second stretch is the same position except now bend your knee and lean forward — you should feel the stretch in the back of the ankle and maybe the Achilles.

Another way to stretch is to sleep in a night splint, which holds your foot in a slight stretch all night. Don’t forget to stretch your great toe into extension; grab your big toe and gently pull back until you feel a stretch in your toe joint or foot, then hold for 30 seconds and perform three times. The big toe tendon slides under the plantar fascia.

Secondly, massage the bottom of your foot with a firm, rolling object. You can start with a tennis ball on the heel while seated or standing and roll the ball while applying pressure to bottom of the foot to massage the plantar fascia for five minutes. For more pressure, choose a golf ball. I have always liked a frozen water bottle or steel can such as a Slim-fast can; you can ice while you massage after a workout or exercise. Use a foam roller to apply comfortable pressure to your calves for five minutes, which helps loosen up the muscles and fascia and increases blood flow to the Achilles.

I like to strengthen the intrinsic muscles of the foot to help support the arch by strengthening those muscles. By targeting the intrinsics, you also bring blood flow into the area, which can bring nutrients the body needs to optimize healing. Some examples of exercise for the intrinsics are toe crunches with a towel, picking up marbles and placing them into a cup with your toes, single-leg balance activities, or walking barefoot on grass or other soft terrain for five minutes. To give these muscles support while you are in the rehab period, you can use tape for the bottom of the foot and Achilles.

I would also suggest a two-week round of over-the-counter NSAIDs if your medical situation allows. If your foot hurts while you run, then don’t run for two weeks; you can get on the elliptical or aqua-jog. If the pain does not resolve in two weeks, then seek professional and formal care from a physician and physical therapist. You may want to consider assessing your footwear or orthotics for running but also during the workday.

Consult with your coach on proper run mechanics and find the right foot strike for your gait and body. Also, consider other factors that impact mechanics such as tight hip flexors, weak hips or knees, etc. Everything is connected and looking at just your foot will not correct the complete problem. The recurrence rate is higher once you have had pain so fix your movement patterns to help prevent this from coming back. Simple plantar fasciitis can develop into chronic fasciosis, which sometimes requires surgery. Athletes tend to push through pain, which can lead to injury, so train smart!

Brad Perry is a physical therapist/partner at Partners in Therapy and a coach/partner at Eleet Fitness. Brad earned his Bachelor’s degree in Exercise and Sports Science and his Master’s degree in Science in Physical Therapy at Texas State University. Brad is a USA Triathlon Certified Coach, a USA Track & Field Certified Coach, and a USAC Certified Cycling Coach. Brad has recently qualified and coached a qualifier for the 2012 Age Group World Championships. Brad is also trained in McKenzie, SFMA, and ART techniques. To contact Brad email him at bperrypt@gmail.com.

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