Common Cause of Heel Pain Shown to Improve More with Manual Physical Therapy than Traditional Therapy

By Stephen Stockhausen, Doctor of Physical Therapy

Ever have a stabbing feeling in your heel with your first step out of bed the morning after a long hike down the Colorado Trail? The stabbing pain is the call sign of a condition commonly called plantar fasciitis.

The plantar fascia is a strong fan-like band of stiff connective tissue that stretches from the base of the heel towards the toes. This band supports the bottom of the foot and is essential for transitioning the foot from a “shock absorbing state” (pronation), when the foot initially touches the ground, to a “force producing state” (supination) for final push off when walking or running. Intrinsic muscles within the foot also assist in providing muscular support. When these structures become over worked or stressed they cause a sharp pain usually felt in middle of the heel. Occasionally there may also be a component of heel pain stemming from a low back problem.

This condition has been referred to as an “itis,” meaning inflammation, but recent research has reported little evidence of true inflammation. Physical changes in the tissues of the plantar fascia are found instead.

Patients are often treated with orthotic devices, corticosteroid injections, night splints, stretching, and a referral to physical therapy.

Traditional physical therapy interventions have included stretching the Achilles tendon and plantar fascia, ultrasound, iontophoresis, and orthotic devices. However, these interventions are often only effective for short term.

A recent study by Cleland et al. in the Journal of Orthopaedic and Sports Physical Therapy showed manual, or ‘hands on’, physical therapy, in which specific techniques were applied to mobilize the joints of the foot, ankle, knee and hip, as well as to the soft tissue of the plantar fascia to be more effective than a traditional physical therapy approach for the treatment of plantar fasciitis. Not only was manual physical therapy shown to have excellent short-term effects, but the benefits lasted at least 5 months after the final treatment was completed.

When you first feel the symptom of Plantar Fasciitis, you should begin self-treatment. A simple and effective technique to do at home is to massage along the bottom of the foot. Push deep and firmly into the soft tissues of the foot, gliding back towards the heel, feeling for any lumps or bumps along the way. These bumps may be painful, but working them out will be worth a few minutes of discomfort. Rolling your foot on a tennis ball or a frozen water bottle are also other ways to do this. Then begin stretching your calf and your hamstring.

So, next time you find yourself limping your way to work Monday morning after a long weekend out on the trails, be sure to give these techniques a try and if symptoms are not resolving, make your way to the nearest manual physical therapist for faster and more permanent results.