I don’t think im alone on this one. 10% of adults will suffer from heel pain in their life. It’s a big cost to the health system. Yet despite the burden of the problem, we don’t actually understand it that well. That is what drove me to spend four years of my life living and breathing plantar heel pain as the subject of my PhD research.
It was an honor to be asked across the Tasman to lecture 300 of New Zealand’s podiatrists on how to best manage heel pain through the prescription of orthotics and footwear.
Now, I’m not saying that the only way to treat plantar heel pain is with orthotics, but we know in a lot of people that they are effective - Our research has proven that. (Stay tuned for a big announcement on our latest findings very soon!)
I gave New Zealand’s podiatrists the same advice that I use to treat patients every day; that every treatment must be designed specifically for the patient being treated. You just can’t expect to give every patient the same treatment and expect everyone to respond in the same manner. It simply doesn’t happen.
At The Biomechanics Lab, we treat 100s of patients each year suffering from plantar heel pain. From experience, we know that orthotics are a great adjunct in the treatment program including other modalities such as stretching, strengthening, weight loss, footwear and load modification.
The lecture I gave in New Zealand took a light-hearted view at how orthotics ‘work’ to help reduce symptoms. We know that really successful orthotics for those with plantar heel pain are largely:
Simply put, if the orthotic is not comfortable, you are likely not to wear it. From our own research data, we know that over 65% of the reason people stop wearing their orthotics is because it is not comfortable. Simple considerations such as the material of the orthotic, the top cover used or the shoe that it is worn can have a dramatic effect on comfort.
There are a number of reasons individuals get pain in the plantar heel. Yet, if we can move the pressure away from the painful areas in your heel, it is likely your are going to be more comfortable and able to walk without a limp or stabbing pain in your heel.
What we are wanting to do with the design of your orthotic is shift what we call the centre of pressure (the point at which the force is applied to the plantar surface of your foot) away from the site of maximum tenderness. That might be forward, or it may also be to the outside of your foot (or both). What we are trying to do here is manipulate the position at which forces are applied to the plantar surface of the foot. Its not about how the foot looks or stopping the foot from rolling in or pronating. The hidden secret of orthotics is that we can actually manipulate forces without seeing a visual change in the posture of your foot. And when we move forces away from painful areas, this is how we acheive a reduction in your symptoms.
The concept of something ‘working’ is quite interesting. It may control the motion of the foot, influences the forces acting on it or change the function of the muscles. But if we don’t see a reduction in symptoms or an improvement in your quality of life, then the orthotic has not ‘worked’.
So there it is – a brief summary of my talk and three key things we try to optimize in the patients we see with plantar heel pain.
Note – we will be continuing this discussion on managing plantar heel pain over the next few weeks. Stay tuned for our next blog on considerations in strengthening the foot and leg in those individuals with plantar heel pain. It’s the hidden gem that gets you back walking and exercising quicker and without pain.
Dr Chris Bishop PhD
Director of The Biomechanics Lab
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