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Heel Pain and Pickleball

With the growing popularity of the sport around the country, there have been more people in the pickleball community complaining of heel pain. Although treatable, plantar fasciitis is a painful and self-limiting condition. Supporting the arch, the plantar fascia, a thick band of tissue connecting the heel to the ball of the foot, can become inflamed or can tear. You experience pain when you put weight on your foot—particularly when taking your first steps in the morning. The pain can be felt at the heel, or along the arch and the ball of the foot.

Plantar fasciitis is a common foot condition. It occurs in as many as 2 million Americans per year and 10% of the population over their lifetimes.

Factors that contribute to the development of plantar fasciitis include:
• Age (over 40 years)
• A job, sport, or hobby that involves prolonged standing or another weight-bearing activity
• Rapid increases in length or level of activity, such as beginning a new running program or changing to a job that requires a lot more standing or walking than you are accustomed to
• Decreased calf muscle flexibility and high arches
• Increased body weight (Body Mass Index greater than 30)
• Improper foot mechanics

Plantar fasciitis affects people of all ages, both athletes and non-athletes. Men and women have an equal chance of developing the condition.

Signs and Symptoms

The onset of symptoms of plantar fasciitis frequently occurs with a sudden increase in activity. You might feel a stabbing pain on the underside of your heel, and a sensation of tightness and/or tenderness along your arch.
People with plantar fasciitis may experience pain:
• In the morning, when stepping out of bed and
taking the first steps of the day
• With prolonged standing
• When standing up after sitting for a while
• After an intense weight-bearing activity such as running
• When climbing stairs
• When walking barefoot or in shoes with poor support

As your body warms up, your pain may decrease during the day but then worsen again toward the end of the day because of extended walking. Severe symptoms may cause you to limp.

How is it Diagnosed?
To diagnose plantar fasciitis, a physical therapist may conduct the following physical tests to see if symptoms occur:
• Massaging and pressing on the heel area (palpation)
• Gently stretching the ankle to bend the top of the foot toward the leg (dorsiflexion)
• Gently pressing the toes toward the ankle

How Can a Physical Therapist Help?
Physical therapists are trained to evaluate and treat plantar fasciitis.
When you are diagnosed with plantar fasciitis, your physical therapist will work with you to develop a program to decrease your symptoms that may include:
• Stretching exercises to improve the flexibility of your ankle and the plantar fascia
• Use of a night splint to maintain correct ankle and toe positions
• Selection of supportive footwear and/or shoe inserts that minimize foot pronation and reduce stress to the plantar fascia
• Application of ice to decrease pain and inflammation
• Iontophoresis (a gentle way to deliver medication through the skin)
• Taping of the foot to provide short-term relief Research shows that most cases of plantar fasciitis improve over time with these conservative treatments, and surgery is rarely required.

KEITH ORI, PT, is founder of Orthopedic Rehab Inc. He has been a practicing physical therapist since 1982. Keith has been at the forefront of developing current protocols that have effectively rehabilitated thousands of clients over the past 35 years.

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