A Pain In the Bottom… Of Your Foot!
As we transition into fall & winter routines, this often means a shift in physical activities, work demands and footwear (hello, winter boots). Sometimes with these changes we can experience pain in our feet.
As a physiotherapist, I have treated my fair share of plantar fasciitis (or more appropriately, plantar fasciopathy) and although this seems to be a frequent referral or “complaint” not all foot pain falls into this diagnosis.
There are many structures that can cause pain and discomfort in the bottom of the foot/heel1, continue reading to learn about common pain patterns and options for treatment!
Pattern 1:
- Gradual onset of pain on the bottom of heel
- Pain with pressure on the heel and push-off phase of walking
- Pain worse in the morning and after ++ activity
- Pain upon standing after sitting a while
Likely Diagnosis: Plantar fasciopathy
Treatment Options: soft-tissue work, cupping, rolling, shockwave, acupuncture, stretches/strengthening/balance exercises for lower body.
Pattern 2:
- Sudden onset of pain on bottom of heel
- Pain worse with direct pressure on the heel, ie. heel strike phase of walking
- Relief with rest and cushioning in shoes
Likely Diagnosis: Heel fat pad syndrome
Treatment Options: heel cup in shoe, taping, low-level light therapy, gait re-training and other exercises to correct imbalances in lower body.
Pattern 3:
- Sudden onset of pain in the bottom of the foot
- Numbness/tingling in the bottom of the foot
- Worsens with straight leg positions (imagine position for stretching hamstring)
Likely Diagnosis: Neuropathy (local nerve impingement) OR Radiculopathy (pain radiating from low back)
Treatment Options: Nerve gliding/flossing, Soft-tissue work, joint mobilizations (ankle and/or lumbar spine), low level light therapy, acupuncture, exercises to correct imbalances in lower body
Pattern 4:
- Gradual onset of pain on bottom of foot, specifically near medial heel or on arch2
- Pain with walking/standing on toes, especially barefoot
- Pain worsens with increased activity and stretching toes backward
Likely Diagnosis: Toe flexor tendinopathy2 or Tibialis posterior tendinopathy2
Treatment Options: Soft-tissue work, stretching, shockwave3, acupuncture and appropriate home exercises (rolling, stretching, strengthening and balance).
Pattern 5:
- Restricted range of motion in the ankle
- Intermittent and diffuse pain throughout ankle
- Sometimes pain worse with higher loads in weight bearing (running/weighted squats)
Likely Diagnosis: Articular joint pain between the talus and the calcaneus
Treatment options: Manual therapy for joint mobility and traction, bracing/taping, soft-tissue work, acupuncture, low level light therapy, gait assessment/corrections, exercises for progressive loading and strengthening.
Pattern 6:
- Gradual onset of pain in heel with weight bearing
- Pain with heel strike and jumping
- Specific area of pain with possible swelling
- Can present after a traumatic event (fall from height) or recent increase in load on feet (ie. increased running intensity or frequency, especially on hard surface like pavement)4
Likely Diagnosis: Calcaneus stress fracture
Treatment Options: Modified gait training and coaching in appropriateness of off-loading4, taping/bracing, low level light therapy.
This list is not exhaustive, as there are various other possible sources of heel and plantar foot pain, which a physiotherapist is trained to evaluate, diagnosis and then treat appropriately!
If any of the above information resonates with you or you’re needing some TLC for your feet (or anywhere on the body!) give us call, we would be happy to help you get back to what you love, pain-free.
References:
- Barrett, S. O’Malley, R. (1999). Plantar Fasciitis and Other Causes of Heel Pain. Am Fam Physician, 59(8):2200-2206
- Simpson, M.R, Howard, T.M. (2009). Tendinopathies Of The Foot And Ankle, American Family Physician. 80(10):1107-1114.
- Robinson, D., Mitchkash, M., Wasserman, L., Tenforde, A.S. (2020) Nonsurgical Approach in Management of Tibialis Posterior Tendinopathy With Combined Radial Shockwave and Foot Core Exercises: A Case Series. The Journal of Foot and Ankle Surgery. 59, 5:1058-1061
- Remi Bergeron, Oct 1-2, 2022, Diagnosis of Running Injuries: Practical Aspects [PowerPoint slides], The Running Clinic, Course 1.1, Dartmouth, NS.