Heel Pain That Won’t Go Away? How Physio and Shockwave Therapy Can Help
Written by Dr. Richard Domenic Simeoni | Nano Physiotherapy | Hornsby, NSW
Heel pain is one of those problems that can start off as a minor annoyance and gradually become something you think about every time you stand up.
A common pattern is pain under the heel with the first few steps in the morning, or after getting up from sitting. It may ease once you start moving, only to return later in the day after walking, standing or exercise.
One of the most common causes is plantar heel pain, often referred to as plantar fasciitis. While many cases improve with time, some become surprisingly persistent.
When that happens, physiotherapy can help by looking at the load going through the foot, improving strength and gradually increasing what the heel can tolerate. For longer-standing cases, shockwave therapy may also form part of treatment.
What Is Plantar Fasciitis?
The plantar fascia is a strong band of connective tissue that runs underneath the foot from the heel towards the toes.
It helps support the arch of the foot and takes considerable load when you're standing, walking and running.
Pain usually develops around the inside or underside of the heel. Typical symptoms include:
Pain with your first steps in the morning
Heel pain after sitting for a long period
Pain after prolonged walking or standing
Increased discomfort after running or exercise
Tenderness underneath the heel
Although the term plantar fasciitis is commonly used, persistent heel pain isn't always simply an inflammatory problem. In longer-standing cases, changes in the way the tissue responds to load can become an important part of why symptoms continue.
Why Can Heel Pain Become So Persistent?
One of the frustrating things about plantar heel pain is that you can't completely rest your foot.
Even if you stop running or exercising, you still need to walk around during the day.
For some people, symptoms start after a sudden increase in activity. This might be starting a running program, increasing walking, changing jobs to one that involves more standing, or returning to exercise after a break.
Footwear can sometimes contribute, but it's rarely the only reason the problem developed.
Calf strength, foot strength, ankle mobility, body weight, activity levels and how quickly your training or walking load has changed can all influence how much stress is placed through the heel.
Strengthening Is an Important Part of Treatment
For persistent plantar heel pain, we generally want to improve the ability of the foot and lower leg to tolerate load.
This will often involve strengthening the calf and muscles around the foot.
Exercises may start fairly simply and gradually become more challenging as symptoms improve. For someone wanting to return to running, for example, rehabilitation may eventually progress towards heavier calf work, hopping and running-specific exercises.
The aim isn't simply to stretch the plantar fascia until the pain goes away.
We want the foot and calf to become stronger and more capable of handling the demands placed on them.
Activity may also need to be temporarily modified. This doesn't always mean complete rest, but reducing the amount of walking, running or standing that is repeatedly aggravating symptoms can give the heel a chance to settle while strength improves.
Can Shockwave Therapy Help Plantar Fasciitis?
For heel pain that has been present for a longer period, shockwave therapy may be considered alongside exercise rehabilitation.
Shockwave therapy delivers acoustic pulses into the painful area around the plantar fascia.
It is commonly used for persistent tendon and connective tissue problems and can be particularly useful when plantar heel pain hasn't improved as expected with more basic treatment.
The aim is to stimulate a biological response within the tissue and help reduce pain.
Shockwave isn't a quick fix, and it doesn't replace strengthening.
At Nano Physiotherapy, we generally look at it as an additional treatment that can be combined with progressive exercise, load management and advice around activity and footwear.
Physiotherapy for Heel Pain in Hornsby
If your heel pain has been hanging around for weeks or months, simply waiting for it to disappear isn't always the best approach.
At Nano Physiotherapy in Hornsby, we assess what may be contributing to your heel pain, including foot and ankle movement, calf and lower-limb strength, activity levels and the things that are repeatedly aggravating your symptoms.
Treatment may include hands-on therapy, stretching where appropriate, progressive strengthening, advice around activity and footwear, and shockwave therapy for persistent cases.
The goal is not just to settle the pain temporarily, but to gradually improve the ability of your foot and lower leg to cope with walking, exercise and everyday activity again.
