HEEL PAIN-Peak Performance PT
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Sep24th 2012

DO YOU EVER WAKE UP WITH PAIN IN THE HEEL OF YOUR FOOT FIRST THING IN THE MORNING? If so, you may have plantar fasciitis, the most common type of heel pain. People with heel pain typically report a sharp pain under their heel that may spread into the arch of the foot. The pain is often worse when the person stands after lying down or following a period of sitting—for example, taking the first couple of steps in the morning or standing up after watching TV. Although the pain may actually decrease with activity, such as walking, it tends to return at the end of the day.

Plantar fasciitis is not typically the result of an injury. Instead, this condition usually develops gradually and, if untreated, may get worse over time. By current estimates, 2 million Americans develop heel pain each year, and about 10% of all people will have heel pain at some point in their lives. The February 2011 issue of JOSPT published a research study that provides new evidence that can help people who suffer from heel pain.

New Insights

In this study, 60 patients with heel pain were randomly placed into 1 of 2 treatment groups. One group of patients performed calf and foot stretches and had hands-on therapy provided by a physical therapist (see drawings below), while the other group only performed the stretches. The treatment performed by the physical therapist focused on treating sore points, sometimes called “trigger points.” Trigger points are small sections of muscles that feel “knotty” and, when pressed, become more painful. The researchers found greater improvements in patients who both performed the stretches and received hands-on therapy. This finding is important because it suggests that people who are not getting better on their own may benefit from hands-on treatment.

Practical Advice

Although stretching the calf and foot can reduce heel pain, the addition of hands-on physical therapy resulted in better pain relief and greater improvements in function during the first month of treatment. The 3 stretches in this study were performed using a 20-second hold, 20-second recovery time and were repeated 3 times, twice a day. If you have heel pain, you may wish to seek the help of a physical therapist who can instruct you on the proper stretching techniques to perform. The physical therapist can also determine if you are a candidate for trigger point soft tissue techniques applied to your calf muscles, as were used in this study. For more information on the management of heel pain, contact your physical therapist specializing in musculoskeletal disorders.

These JOSPT Perspectives for Patients is based on an article by Renan-Ordine R, et al, titled “Effectiveness of Myofascial Trigger Point Manual Therapy Combined With a Self-Stretching Protocol for the Management of Plantar Heel Pain: A Randomized Controlled Trial.” (J Orthop Sports Phys Ther 2011;41(2):43-50. doi:10.2519/jospt.2011.3504)

This Perspectives article was written by a team of JOSPT’s editorial board and staff, with Deydre S. Teyhen, PT, PhD, Editor, and Jeanne Robertson, Illustrator.

For more information visit the full article at http://www.jospt.org/doi/full/10.2519/jospt.2011.0501#.VHuGXdJ0zIU