Why Does My Heel Pain Keep Coming Back?

Posted 7 Jan

What’s even worse than having heel pain that stops you from being able to work towards your health and fitness goals, or even comfortably manage your day-to-day life? It’s having heel pain that you think has gone for good, but it just keeps coming back, no matter what you try to do to help.

Yes, unfortunately it’s a common scenario that a person with heel pain tries to do everything they can at home - like shifting from running to walking, rolling their foot on a frozen water bottle, switching to nice supportive joggers - only to have their heel pain recur for months or even years.

So why does this happen? For many of the people we see, while their home efforts have been good for relieving some of their painful symptoms (temporarily at least), the answer lies in the fact that the underlying cause of their heel pain is never actually addressed. And that right there is the absolute key to long-term foot health and heel pain being “fixed” for good.

Why Pain-Relieving Measures Aren’t Enough

To best understand why getting to the underlying cause of heel pain is so important - and why it’s a key focus of what we do here as podiatrists - let’s use an analogy. Say you’ve become a keen jogger who is managing to get a 30 min jog in about 4 days per week. In this example, it could really be a jog, walk, run, gym session, zumba class - any form of exercise. Anyway, after your heel pain started one day almost spontaneously, without a distinct ‘event’ to trigger it (like hitting your foot against something or jumping down from a high surface), you notice that it has periods of feeling better and worse throughout the day. Typically, it feels worse first thing in the morning for the first 1-3 minutes, as well as when you stand up after resting. But while resting, it feels much better. Sometimes, your heel also starts hurting towards the end of or after your jog, and again, feels much better during a rest.

You know that you’ve always had a flatter foot type due to the way your foot flattens down on the floor when you stand, even though it appears to have an arch when you’re sitting down and raising your foot off the floor. At some point, you read online that flatter feet need more arch support to help with heel pain, so purchased an expensive pair of jogging shoes which feel fantastic on your feet. But yet, your on-again-off-again heel pain continues.

As you’ve got health and fitness goals, with one of them being maintaining regular jogging, you then start trying more things to help: you downgrade from jogging to brisk walking. When your pain starts, you’re quick to follow the PRICE principles (protection, rest, ice, compression, elevation). You’ve even learned to strap your heels and feet, which you do before a lengthy jog or brisk walk, and recently have even purchased some cushioning, silicon insoles from the pharmacy that you keep in your sports shoes. You roll your feet and heels on frozen water bottles when you can remember or when your heel feels particularly hot or sore.

On the outside, it feels like you’re doing everything to help, and that you’re doing a good and consistent job of it. But yet, morning after morning, the pain is still there. And then you get a period where the pain either lessens significantly or disappears, but then it just starts up again, without explanation. So what’s going on?

The problem here is that almost all the measures that are being taken are designed to help relieve symptoms and help prevent the problem from worsening - but it’s not designed to get rid of the pain for good by addressing what is causing it in the first place. It’s just like finding lots of different ways to mop up water from a leak you’re having in your home, without ever fixing whatever is causing it to leak in the first place. And actually fixing that leak is where you’re going to find long-lasting relief from your heel pain.

• Switching from jogging to brisk walking is great to help reduce the strain and pressure on the heels, but as soon as you jog again, or the demands of your daily life mean you have a long hard day on your feet, your plantar fascia (the cause of the heel pain) will be overloaded again, which is likely to lead to inflammation, pain and further damage (meaning more pain for you the following morning and day)
  
• Following the PRICE principles (protection, rest, ice, compression, elevation) is an effective way of giving you symptom relief, especially during a time when your heel pain has flared up. But as soon as you stop doing them and are back on your feet, you’re vulnerable to overloading your feet and your symptoms recurring.
  
• Learning to strap your feet can be really helpful to keep your heels and arches supported when you know you’re going to be on your feet for a while. Unfortunately, as soon as the strapping comes off or you have an exercise session without having your feet strapped, you’re vulnerable to pain and further injury again.
  
• Purchasing some cushioning gel-like insoles from the pharmacy can help you feel more comfortable on your feet, but aside from the cushioning, they won’t be doing anything to actually support your arch in the long-term, or address the cause of your heel pain. Unfortunately, there’s a very big market for one-size-fits-all insoles that claim to help with various foot problems, but the true medicine and power in orthotics is their custom nature - orthotics should be designed specifically for your feet after a comprehensive assessment of your feet, and after taking a 3D scan of your feet to ensure the right fit and function. Just like how picking up a pair of one-size-fits-all glasses from the supermarket won’t help you in the long run if you have notable recurring vision problems - only prescription glasses from your optometrist will do that.
  
• Rolling your foot on a frozen water bottle can help with any inflammation and pain, but it doesn’t change the fact that when you walk on an unsupported fascia (the connective tissue that runs across the arch), you can easily worsen your injury and cause more pain and discomfort.
  
• In this scenario, while getting good supportive joggers is a fantastic idea, the fact that you’re still experiencing on/off pain tells you that it’s not enough, and your injury requires more care and treatment to get the results you need. 
  

Getting Rid Of Heel Pain For Good Can Be Easy With The Right Treatment

The good news is that if you know exactly what your diagnosis is, which tissues or muscles are being damaged and how, and all the contributing factors in your daily life that may be keeping your heel pain flaring up, then it’s a relatively straightforward path to achieving long-term pain relief.

Here at The Feet People in Brisbane, we do this by:

• Completing an assessment that identifies any other contributing factors to the injury, such as tight calf muscles that are pulling on the heels, as well as any muscle imbalances (weakness, tightness, limited range of motion at the joints, etc)
  
• Conducting a video gait analysis so you know exactly what is happening during gait in relation to your foot biomechanics, so we know exactly what to include in your management for permanent relief
  
• Coming up with the right components of your treatment plan that includes stopping you overloading the heels, arch and plantar fascia - such as with custom foot orthotics
  
• Ensuring your shoes are supporting your healing and not hindering your progress due to their wear and tear, and even having custom footwear modifications if needed based on your foot characteristics and needs
  
• Ensuring the plantar fascia is set up for healing (so all the micro-tears and damage to the muscle fibres are repaired), and that they will then continue to be offloaded by the orthotics when you’re active to stop the injury from occurring again
  
• Using innovative treatments such as shockwave therapy or MLS laser pain relief to accelerate your healing and repair, so you get rid of your pain for good, faster
  
• Getting you on the right physical therapy program to account for any muscle imbalances or restrictions identified in your exam
  

Plantar Fasciitis Heel Pain: Recap

Being one of the most common conditions that our podiatrists see and treat, here’s a quick recap on plantar fasciitis heel pain, the leading cause of heel pain. Plantar fasciitis describes damage to your plantar fascia, a thick connective tissue band that originates from your heel and then spans your foot like a fan to connect to all five toes and helps to facilitate the function of the foot and arch, and maintain its shape, strength and flexibility.

The most common cause of plantar fasciitis is from overuse, specifically overloading the heels and arches. The result is heel pain on the very bottom of the heel, where the fascia originates, that tends to worsen with exercise and be relieved with rest. One of the telltale signs of plantar fasciitis is “first step pain” in the morning, which starts intensely and eases as you continue to walk, which is described by the majority of our patients. Some also feel this when standing after they’ve put their feet up to rest throughout the day.

We’ve detailed a lot more about the symptoms, causes and treatment of plantar fasciitis heel pain here, and have also debunked some common myths about heel pain here, which is a very interesting (and surprising) read for many.

Struggling with recurring heel pain that you just can’t shake?  We’re here to help.

Book your appointment with our podiatry team online here or call us on (07) 3356 3579.