Treatment options for chronic heel pain in runners

Epidemic of Heel Pain in the running population

Heel pain is the most common complaint that we see in our office. The typical ages of complaints of heel pain are between the age of 40 and 60, which is the largest age segment in our population.

There is a growing consensus of opinion that plantar fascitis is best treated non-surgically with the vast majority of patients becoming asymptomatic within twelve months of the onset of symptoms.

During this time of the year many of our patients are training for upcoming races such as the Cooper River Bridge run and various ½ and full Marathons. We would like to discuss our experience with treating heel pain in our running population and state of the art treatments if heel pain is a chronic issue.

PATHOMECHANICS

Contributing factors are tightness of the achilles tendon, overload of the soft tissues, leg length inequality, excessive flattening of the arch, high arched feet, and high impact sports. It is well accepted that the common athlete presenting with heel pain has a medium to high-arched foot.

TREATMENT STRATEGIES FOR THE ATHLETE

In most cases, the goal of the athlete ie. runners is to quickly return to activities to minimize loss of fitness and performance. In our practice we see a high volume of recreational and seasoned competitive runners

1) Assignment to alternative activity

The athlete must be encouraged to maintain cardiovascular fitness during rest from damaging activities that may delay healing. For the running population that suffers from heel pain we try to encourage cross training to lessen the load on the feet. The goal should be assigned to alternative cardiovascular fitness activities that minimize impact and loading on the plantar fascia including stationary cycling, swimming, yoga, pilates, upper body weight machines, and low resistance flat-footed stair master machines These activities help to maintain physical aerobic fitness as well as keep the ligaments and tendons flexible. In addition if you are currently training for a road race lessening the amount of days with respects to your running schedule can be a big help. Personally I was suffering with some minor heel pain and was training for the Charleston ½ Marathon. I changed my frequency of training during the week in which I ran two shorter runs during the week and a longer run on the weekend. This was a three day a week training schedule for 8 weeks and it made all the difference in the world for me.

2) Change and modulation of footwear

Footwear analysis is critical for evaluating athletes with chronic heel pain. The footwear may be a contributory factor and can be utilized as a powerful treatment modality. Athletes should be placed into shoes that have a minimal 1" heel height with a strong stable midfoot shank and relative uninhibited forefoot flexibility. The American Academy of Podiatric Sports Medicine has a list of recommended footwear for the athlete that can be obtained on their web site: www.aapsm.org.It is well recognized that recent trends in athletic footwear have actually predisposed to greater frequency of plantar fascitis due to the fact that athletic shoes have weaker midsoles with newer designs. The popular "two-piece" outsoles with an exposed midsole cause a hinge effect across the midfoot placing excessive strain on the plantar fascia in the running and jumping athlete. These shoes must be eliminated if the injured athlete is wearing them. We recommended around the house to wear oofos or vionic sandals especially if you have hard wood floors.

3) Home therapy

Runners are accustomed to designing and participating in their own training programs. They are willing participants in their own treatment programs. Heel cord stretching is central to the rehabilitation process to decrease load on the plantar fascia and encourage healing. The use of plantar fascia night splints has been well proven to be a treatment adjunct for plantar fascitis by placing the heel cord and the plantar fascia on a sustained static stretch during sleeping hours while preventing the normal contractures that occur in the relaxed foot position during sleep. We recommend runners roll or massage their foot on a golf ball or tennis ball is helpful to improve blood flow and break down adhesions in the injury site.

4) Custom foot orthoses

Intervention with semi-rigid custom foot orthoses has been well proven in many prospective and retrospective studies showing successful outcomes in patients with plantar fascitis. In the athlete, the use of foot orthoses should be considered earlier than in the average sedentary patient because of the fact that the athlete will be subjecting their feet to greater stresses during treatment and certainly after return to activity. Athletic footwear is more amenable to semi-rigid and rigid orthotic therapy than are casual shoes worn by sedentary patients. We like our runners to be fitted for plantar fascial and achilles foot sleeves which help to take the strain and stress off the plantar fascia while running.  We also teach our patient about specific taping methods such as low dye taping that can be applied on the bottom of the foot to take the strain off the plantar fascia.  arch taping procedures.

5) Physical therapy

Physical Therapy is an effective modality for runners because investing this time can help to maintain and increase flexibility. We are big fans of ultrasound, cupping, dry needling, and iontophoresis.

6) Anti-inflammatory medication

Anti-inflammatory medications and cortisone injections can be used in the right situations to decrease inflammation and reduce soft tissue swelling. We typically will start with a short term course of oral NSAIDS and if the heel pain is severe enough will consider a series of cortisone injections to not exceed three in a given year.

7) EPAT (Shockwave Treatment)

The EPAT procedure is a state of the art non-invasive treatment for chronic plantar fasciosis and achilles tendonitis. The procedure is performed in the office setting without anesthesia. The procedure involves sending high energy sound waves into the heel to break up scar tissue and increase circulation so that the body heals itself. This is becoming the standard treatment for chronic heel pain and has a 85% resolution of heel pain 8-10 weeks out from the initial treatment. We have had a great number of runners suffering from chronic heel pain over the past few years do very well with this in office procedure.

CONCLUSION:

Runners presenting with plantar fascitis must be treated aggressively because they have immediate needs and long-range goals that are different than those seen in the average sedentary patient with heel pain. It is important to be aggressive and employ a variety of modalities and treatments when formulating a treatment plan for the athlete

The cornerstone of plantar fascitis treatment for the athlete is biomechanical. Podiatric practitioners possess the greatest skill set and knowledge available in medicine today to adequately address the pathomechanics of plantar fascia overload. The use of properly casted and designed custom foot orthoses should be the cornerstone of non-surgical treatment of subcalcaneal pain in the athlete.

We would like to talk about a common heel pain condition that we see in children and adolescents between the ages of 8-16. Sever's Disease or Calcaneal apophsitis is a growth plate injury of the heel often misdiagnosed as plantar fascitis. We are starting to see this injury more often most likely because of year round travel sport teams as well young children specializing in one sport without  variety as well as much needed rest. This is typically an overuse injury of the growth plate of the heel. The heel bone is called the "calcaneus" and has an important growth plate at the base. Boys from 8 to 14 and Girls 7 to 13 can have pain develop in this area either from the pull of the achilles tendon, or the pull of the plantar fascia. We see this in sports such as basketball, running, baseball, gymnastics, and tennis. After those ages, the growth plates will fuse and there can no longer be a source of pain. This form of heel pain can disrupt activity and be frustrating for children as well as their parents. If recognized and diagnosed promptly, conservative treatment will usually resolve this condition rather quickly.

     The basic rule is to create a pain free environment with no limping. Treatment consist of ice, oral NSAIDS, stretching, achilles/plantar fascial night splint, heel lifts/heel cushions, custom orthotics, physical therapy, and in extreme cases cam walker boot/cast immobilization. Physical therapy modalities such as electrical stimulation, iontophoresis, dry needling of the calf, and achilles stretching can be useful ways to resolve this condition. Brief modification of exercise routine to more low impact can help the growth plate to heal.

If your children are suffering from heel pain it is important to have them seen as soon as possible. The faster that this condition is recognized and treated the quicker your children will have resolution of heel pain which will allow them to resume to the sports that they love to participate in.

For more information please refer to our website: www.carolinafootspecialists.net

Please check out this very informative blog that discusses heel pain in adolescents. We see many young athletes that present in our offices with heel pain. A good majority of the time it is a growth plate injury of the heel called Calcaneal apophysitis or Sever's disease. Fortunately this is a treatable condition if recognized early.
If your child is suffering from heel pain that has not improved after a few weeks please call our offices so that we can resolve this specific injury.

http://www.drblakeshealingsole.com/2011/11/severs-disease-growth-plate-injury-in.html

Do heel spurs causes heel pain?

https://www.verywellhealth.com/heel-spur-diagnosis-and-treatment-2548574

EPAT procedure for Chronic Heel Pain

Shockwave (EPAT)

Shockwave (EPAT) 

https://www.carolinafootspecialists.net/services.html

 

WHAT IS EPAT THERAPY?
EPAT therapy is a highly effective treatment method: high-energy sound waves are introduced into the painful areas of the body. It is one of the most advanced and highly effective noninvasive treatment methods cleared by the FDA. The treatment works by helping to improve the regenerative potential, enhancing blood circulation to regenerate damaged tissue.
EPAT also known as Shockwave and Pressure Wave Therapy can successfully address all musculoskeletal pains and injuries of of the foot and ankle inlcluding plantar fasciitis/heel pain, achilles tendonitis, turf toe, stress fractures, Posterior tibial tendonitis, and other tendonitis in the foot and ankle.
Treatments typically take about 5-10 minutes, depending on the disorder being treated. Generally 3 treatments are needed each about 1 week apart. The benefits are often seen after only 3 treatments with some patients experiencing immediate pain relief. The non-surgical therapy for pain eliminates pain and restores mobility, thus quickly improving patients’ quality of life.
Call us to learn more about how EPAT Therapy can address your pain, accelerate your healing and optimize your health.
BENEFITS OF EPAT TREATMENT

• 91% Success Rate (as per clinical studies)
• Non-invasive
• No anesthesia required
• No risk of infection
• No scarring
• No downtime
• Over 80% patient satisfaction
• Cost effective
• Faster, easier healing

Foot-Friendly Tips to Prevent Common Running Injuries

Making running part of a workout routine leads to better physical stamina and a more positive state of mind—but a detrimental foot injury can quickly stop runners in their tracks. Keeping feet healthy and pain-free can go a long way toward ensuring that every run is enjoyable, for both experienced runners or for those just starting out. Carolina Foot Specialists would like to give you some New Year’s tips before hitting the trail or treadmill, which can keep your foot and ankle injuries at bay.

Some of the more common running-related foot injuries our foot specialists treat include arch pain, tendonitis, and blisters. If runners can take just a few minutes to stretch properly pre-workout, select appropriate footwear, and see a podiatrist immediately when foot pain occurs, many of these ailments can be avoided entirely.
Select a good running shoe: A running shoe purchase is dependent upon the type of foot and function of the foot for the individual. Runners should research shoe construction and keep in mind that footwear can vary in size from one manufacturer to the other. It may be worth spending a little extra money going to one of the local running stores in your area to make sure you are fitted correctly.
Select good socks: Runners should always fit shoes with the socks that they plan on wearing during a run. Socks should be made of a poly-cotton blend that pulls moisture from the skin, fit well, and be comfortable when worn with a running shoe. Cotton socks should be avoided because they hold in moisture and can contribute to blister formation.
Stretch out and build momentum: Before a run, begin by warming up and gently stretching for 5-10 minutes, focusing on lower leg muscles. Amateur runners should start with short distances, increasing distance over time to help prevent injury. All runners should begin every workout slowly, as this allows the body to warm up further and decreases the chance of muscle strain. Runners should also focus on keeping both the feet and entire body relaxed, avoid tensing or cramping toes, and run with a gait that feels the most natural. Cease running immediately if any pain is experienced.
Cool down and rest: After reaching the end of a running workout, cool down and stretch for about 10 minutes. Submerging the lower extremities in an ice bath after longer runs can reduce muscle soreness, as can the use of a self-massager designed for post-athletic activities. Epsom salt soaks in warm water can help to reduce muscle soreness as well.
Muscle pain is common after exercise, and minor injuries may be treated with the RICE regimen (rest, ice, compression, elevation). However, if foot pain does not resolve itself after several days—or returns immediately upon resuming exercise—runners should seek out care from a Sports Podiatrist who has expert experience with sports related foot injuries.
Frequent runners should see a podiatrist on a regular basis to maximize any running program and prevent serious injury. For more on running and foot health, visit our website at carolinafootspecialists.net