A young woman spoke to me about excruciating pain she was developing under her left heel. As she was a tour guide in various Asian countries, she was on her feet all day and the problem was increasing. When she woke in the morning it was not painful until she stood up and started walking on it, whereupon the pain increased. As her job involved a lot of walking, usually on hard surfaces such as pavements, her occupation was at risk.
Diagnosed as plantar fasciitis, the pain she was experiencing was a sharp stabbing pain on the bottom of her left heel (when walking or running) and she had been having a problem for several months now. It is quite common and is usually caused by excessive strain on the plantar tendons. These tendons form the arch of the foot, starting at the heel and running up to the ball of the foot. Over time, this strain can tear the tendon; repeated stretching and tearing causes pain and inflammation.
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As she was in her early 40s, she was in the age group that is more likely to develop this condition. Over the years she had also gained some weight, which is one of the risk factors. Another common scenario is when the Achilles tendon is tight and the foot mechanics change: the arch starts to flatten, placing additional stress of the tendon — called “overpronation”. A common sign of this is when the outer part of the heels of the shoes start to wear away more quickly than other parts. This can be a problem with her gait or walking pattern. In an attempt to gain fitness she had also started an aerobic exercise program in the last few months, mainly running.
Interestingly, overpronation is a very common foot condition. It affects at least half of the Australian population and is the major cause of plantar fasciitis and ultimately heel spurs.
My client had spoken to her GP who had recommended cortisone injections in the area. Cortisone injections provide relief in many cases but do nothing about fixing the underlying problem, so she did not want to accept this treatment until she had tried other ways of healing it.
Recommendations
Professional running or walking shoes were recommended. With good arch support and a slightly higher internal heel, these can be designed specifically to relieve foot pronation (rolling of the foot associated with arch flattening). A slightly higher heel can reduce the stress on the plantar fascia, leading to a reduction of pain.
Arch support devices or orthotics were highly recommended to raise the arch of the foot and therefore reduce strain on the plantar tendon. Orthotics can be designed to correct an incorrect gait, in particular overpronation. A semi-rigid one is usually best for this (rather than gel arch supports). While many of these available commercially are successful, in her position, a visit to a podiatrist was recommended to have inserts designed specifically for her foot.
As part of this, avoiding slippers or sandals or walking barefoot was recommended until the foot was healthy again, as these do not provide the foot support needed at this time.
Stretching exercises were recommended each day before and after walking or exercising. Stretching the calf muscles regularly will help protect the Achilles tendon, ensuring the feet land correctly during walking and running.
Resting the foot for a few weeks is a good idea but this was not possible until the tourist season was over. However, that would occur in the next couple of months and there was going to be a natural break in her workload that she was advised to take advantage of. In terms of her exercise program, cycling or swimming were better options as these exercises do not stretch the tendon or put weight on the painful heel.
For temporary relief, ice packs can be placed on the heel for 5–10 minutes to “cool” the inflamed area. For longer-term pain relief, a glucosamine and chilli cream was recommended to be applied several times a day while massaging the area. This has an anti-inflammatory effect when applied topically and will ultimately strengthen the cartilage as it provides the nutrients necessary to do so.
Anti-inflammatory herbs and nutrients were also recommended, a combination of turmeric and boswellia, devil’s claw and white willow bark, along with quercetin and bromelain.
It often takes 6–12 months to heal the cartilage properly so any treatment was going to be long term and, for a condition like this, combined with her job, the treatments suggested provided a pattern for prevention of the condition in the future.
The overall outcome of this program was very positive and she had almost complete pain relief within four months but has continued with the suggestions to make sure it does not reoccur. She is back full time as a tour guide, walking everywhere, and is very happy with the result.
