“Scraping” is a broad term that applies to several specific treatment methods used to alleviate heel pain from plantar fasciitis and promote healing.

All scraping and soft-tissue mobilization techniques use tools to apply pressure and movement to the arch and heel, in order to break up adhesions beneath the skin, promote increased blood flow and circulation to the injured area, and reduce contracture in the plantar fascia. However, each method of scraping is distinct, and knowing the difference between the most popular methods can help you choose the best scraping therapy for your unique lifestyle and situation.

Let’s explore the most popular methods of scraping and soft-tissue mobilization:

IASTM

IASTM stands for “Instrument-assisted soft-tissue mobilization” and is an umbrella term to describe a wide range of scraping tools and techniques for heel pain. The Graston Technique and Gua Sha (read more about them below!) can be grouped under the term IASTM.

Studies gaging the effectiveness of IASTM are still emerging, so it’s important to take “miracle” claims with a grain of salt. However, some studies do seem to show short-term benefits in improving range of motion and temporary pain relief. Like all scraping techniques, IASTM should be used as just one part of your approach to healing plantar fasciitis, with the understanding that IASTM treats symptoms rather than the root cause of plantar fasciitis.

It’s also important to choose an IASTM provider carefully, since individuals who are not properly trained to use scraping tools can cause unnecessary pain and do damage to healthy tissue by applying too much pressure. Keep this same caution in mind when purchasing IASTM tools on the internet to use scraping techniques yourself.

Graston Technique

The Graston Technique is one of the most popular forms of scraping. In the Graston Technique, a provider uses patented stainless steel instruments (think dull butter knives) to apply progressive pressure to the plantar fascia in seven different stroke techniques. This pressure and movement helps break up scar tissue, improve blood flow and range of motion, and lengthen the plantar fascia. The technique is very popular with many athletes, and when done properly causes very little discomfort. While the research supporting the Graston Technique’s effectiveness for plantar fasciitis is still emerging, many people swear by its effectiveness and report significant pain relief.

Typically, Graston Technique is done once or twice each week, for six to eight weeks. Therapy sessions are often covered by insurance, and cost between $60-$90 per session.

Gua Sha

Gua Sha is based in Chinese medicine and is a form of IASTM that uses instruments to apply significant pressure to the skin that often leaves redness and bruising. The Gua Sha provider will apply a thick layer of oil to avoid damaging the surface of the skin, then apply a steady, stroke across the skin with a dull, smooth instrument like a rounded piece of jade, a smoothed animal horn, or even a spoon.

The motion of Gua Sha is more of a true “scraping” movement across the skin, without much variation in the stroke, while Graston uses seven different motions to gradually apply deeper and varied pressure. It’s believed that the heat and inflammation caused by the scraping of Gua Sha encourages a healing response from the body in the treatment area and releases harmful toxins that may play a role in inflammation of the plantar fascia. You’re likely to find a Gua Sha provider at an acupuncturist or traditional Asian therapies clinic. Costs are typically similar to acupuncture and run anywhere from $40 to $70.

Deep Tissue Massage

Deep tissue massage uses the fingers as a scraping tool by applying significant pressure to the plantar fascia in short. Slow strokes. The goal, as with Graston and IASTM is to break up adhesions and scar tissue, improve circulation, and relieve pain through pressure. If the idea of scraping instruments bothers you, or you don’t have a Graston provider nearby, deep tissue massage can be a great alternative.

It may be helpful to choose a massage therapist with a background in sports medicine, since he or she is more likely to be familiar with the anatomy of the plantar fascia. Make sure to communicate with your therapist throughout the process of deep tissue massage; intense pain isn’t normal or desired, but it can be difficult for your therapist to know what you’re experiencing without clear communication! The cost of deep tissue massage varies greatly from provider to provider and can run anywhere from $30 to $150 per session.

Supplementing Scraping Techniques

Because the research on scraping techniques and plantar fasciitis is still emerging, it’s still unclear whether these techniques are more effective than simple self-massage with a golf ball or mobility ball. However, scraping techniques like Gua Sha, Graston, and deep tissue massage are relatively inexpensive, non-invasive, and have few potential side effects.

Given the small body of available research, it’s also difficult to say whether a particular scraping or soft-tissue mobilization technique is better than another; however, knowing the subtle differences between each method can help you decide which one appeals to you the most.

No matter which scraping technique you decide to try, make sure you’re also incorporating treatments to target the root cause of plantar fasciitis, like stretches that strengthen the plantar fascia and surrounding muscles and ligaments, wearing orthotic inserts to lift the damaged fascia to its optimal height while easing pain, and address other trouble spots like poorly fitting footwear or weight gain that is putting extra strain on your arches.

Supination, also known as underpronation, is the name for the movement that occurs when your foot rolls outward at the ankle while you walk or exercise. Some supination is completely normal.

However, excessive supination should be corrected and addressed, since it can lead to pain, injury and tissue damage. Individuals with high arches are particularly susceptible to supination.

If you underpronate while you walk, you may notice arch pain, heel pain, and even back and knee pain because of the additional stress this abnormal gait places on the body.

Over time, supination can also result in plantar fasciitis, bunions, heel spurs, sprained ankles, stress fractures, and tendonitis.

Wear the Right Shoes, and Add Ankle Supports

Shoes play an important role in correcting supination by keeping the foot properly aligned and supported in the heel, arch, and ankle areas while you walk or run. Proper footwear is especially important during high-impact activities like jogging, sports, or exercise routines, since high levels of force absorbed by the foot will also exacerbate supination.

Shoes should be comfortable, closely fit the contours of your feet without being excessively tight, and be the correct side in length, width, and depth. Shoes should have thick, flexible soles with plenty of tread, and a layer of cushioning throughout to help absorb impact. Keep in mind that feet may continue to grow over the course of a lifetime, so don’t assume that your shoe size 10 years ago is still your shoe size! You’ll also want to do your shoe shopping at the end of the day, when your feet are most likely to be slightly swollen.

Under-pronators may also want to consider high-tops, which extend over the ankle, ankle supports, or KT tape to provide extra support.

Stretch Your Tendons and Ligaments

Supination or underpronation is very common in people who have tight Achilles tendons. Why? A tight Achilles tendon restricts proper range of motion in the ankle and foot, which can lead to gait problems. Stretching not just your Achilles tendon but your calves, hamstrings, quads, and thighs, will result in stronger, more flexible muscles, tendons, and ligaments that work together for a healthy gait.

Think of your feet, legs, and ankles like an ecosystem: When one part is injured, tight, or underutilized, the entire system suffers! By staying diligent about stretching and strengthening all these muscles, tendons, and ligaments before and after exercise, as well as during the week periodically, it’s possible to correct and improve a problematic gait.

Correct Your Gait with Orthotic Inserts

Orthotic inserts like clinically-proven Heel Seats can be a very effective tool in correcting supination with the added benefit of relieving heel pain caused by plantar fasciitis and heel spurs that may have developed as a result of supination.

Orthotic inserts can be swapped in and out of almost any pair of shoes and add another level of structural support and cushioning missing from many running shoes. And orthotics like Heel Seats, which incorporate Fascia Bar Technology, help the foot properly distribute impact, stretch the plantar fascia, and raise the arch to an optimal height. Since many individuals with  have unusually high arches, it’s especially important to hit this optimal height while moving and exercising.

Rest Those Feet

Like many foot problems, overuse and repetitive stress are big risk-factors. Overuse can cause micro-injuries, strain, and inflammation in the different tissues of the foot and legs. And that strain encourages the body to overcompensate by adjusting the gait, to favor the injured or overused area. These adjustments may favor the injured area–while creating a problematic gait like supination.

To help correct supination stemming from overuse, be diligent about resting your feet between high-impact activities like basketball, soccer, jogging, and crossfit. Avoid back-to-back high-impact activities, and give your feet time to recover. It’s also important to ramp up slowly when starting a new exercise routine or activity, to give your feet time to adjust.

Warm Up and Cool Down Properly

One of the simplest and most effective way to correct the problem of supination is to make sure you’re warming up and cooling down properly before and after exercising. It’s easy to forget, and it can feel like an inconvenience, but these steps help tissues in the feet and legs get ready to work, stretch, and properly bear impact.

If you suspect that you might supinate or underpronate while you walk or move, you may want to have your gait tested at a running shop or sporting goods store. Many offer this valuable service for free!

Correcting excessive supination is, in most cases, a simple matter of diligence in proper footwear, warmup and cooldown, stretching, and support. However, don’t let the simplicity of these fixes fool you; left uncorrected, excessive supination can and does lead to injury and significant strain to the feet and surrounding tissues. A balanced gait is key to staying active and healthy!

 

 

When it comes to heel pain, who wouldn’t want an extra helping hand (er, foot) to improve some of the pain and instability of a compromised arch?

The more support the better–right?

That’s the logic behind many people’s choice to use a walking boot, night splint, or brace in addition to other conservative treatments for heel pain. However, while some of the devices that provide additional bracing and arch support can be extremely useful and beneficial when used properly, it’s important to know which products are best used for which purposes–and potential drawbacks of each.

Here’s what you need to know about braces, supports, and heel pain:

All About Heel Pain Walking Boots

A walking boot is sometimes prescribed by doctors or podiatrists for severe heel pain to help immobilize and rest the foot while the plantar fascia has a chance to heal. Walking boots can provide several important benefits, when used properly. But it’s also important to be aware of their potential drawbacks:

Pros

Walking boots are most helpful in cases where the pain from plantar fasciitis is very severe and has not responded to conservative treatment methods like stretching, icing, and orthotics. In these cases, an individual will often be preparing for surgery or other medical interventions, and needs a tool to alleviate severe pain while walking during the daytime. Walking boots can also be very helpful during the recovery period after foot surgery.

Cons

If you’re using a walking boot to treat mild to moderate plantar fasciitis, just remember this fact: in most cases of plantar fasciitis, the pain is worst in the morning when the plantar fascia is tight and unstretched. That pain usually improves somewhat throughout the day as the fascia moves, loosens, and stretches. While rest is important to healing the inflammation and small tears that a damaged fascia sustains, you should take care in how much you use immobilization of the foot as a treatment. Strengthening, stretching, and supporting the fascia while allowing your foot to move normally will ultimately result in a healthier, stronger fascia as well as preventing surrounding muscles and ligaments from atrophy through disuse.

All About Night Braces/Night Splints

Night braces or night splints keep the foot gently flexed while you sleep. Why? To significantly reduce that hallmark morning pain associated with plantar fasciitis. If the foot is able to maintain this stretch all night long, the fascia stays stretched, limber, and significantly less painful in the morning:

Pros

A comfortable, quality, properly fitted night splint or brace with the right amount of stretch can be an invaluable tool in reducing morning pain from plantar fasciitis. And if a traditional night splint feels too bulky or uncomfortable, there are several great options for sock night splints that provide a stretch on par with their heavyweight counterparts. Night splints and socks can be a great complement to the stretches you do during the day to strengthen and stretch your fascia.

HTP Night Splint

Cons

The wrong night splint or brace can be uncomfortable at best, with the wrong amount of stretch at worst. You’ll want to note the width of the night splint compared to your foot, and how comfortable the straps are. It can be extremely difficult to sleep if the straps dig into your skin, and the brace can be rendered less effective if your foot slides around when you change position during the night. Pay close attention to user reviews and company reputation when purchasing a night splint or brace, to get a good idea of what customers’ experiences are like.

So, What About Orthotics?

Any conversation involving support, stretching, and bracing should mention orthotics. Can the type of support offered by orthotics be a roadblock to healing in the same way improper use of a walking boot can? And are some types of orthotics more effective in improving plantar fasciitis than others?

While it’s true that not all orthotics are created equal–many are just shaped foam that collapses over a short period of time–orthotic inserts made especially for plantar fasciitis will help rather than hinder your healing in the support department. The arch of the foot is ideally suited to a particular height. Too low or too high, and the foot has a hard time distributing body weight and impact properly. Add in factors of overuse, high impact activities, and fluctuating body weight? It’s no wonder our arches can use a little support in maintaining that optimal height. Wearing orthotics is simply a way to help ensure that your arch maintains a healthy position, so it doesn’t suffer injury.

And when the arch does become compromised, using conservative treatment methods like stretching, icing, rest, night splints, and walking boots in more severe cases, can help manage the pain from plantar fasciitis while getting your arch back into shape.

Pain in the ball of the foot usually points to one of two conditions: Morton’s Neuroma or Metatarsalgia. The key symptoms of both foot conditions include pain, numbness, and inflammation near the ball of the foot–which can make it very difficult to tell which condition you’re dealing with!

Fortunately, while Morton’s Neuroma and Metatarsalgia are similar in many ways, there are several notable differences that can help you and your doctor determine the source of the pain in the ball of your foot.

Common Causes and Symptoms of Metatarsalgia

Metatarsalgia is caused by trauma and inflammation in the metatarsal heads–the five bones that connect each of your toes to your foot. This pain and inflammation can have numerous causes, including abnormal arches that place pressure on the metatarsal heads, improper footwear, degenerative diseases like arthritis, nerve disorders, diabetes, Freiberg Disease, Sesamoiditis, obesity, or simply the aging process.

Symptoms of Metatarsalgia include the following:

• While pain can be severe and seem to affect the whole foot, the worst pain is concentrated at the ball of the foot.
• Numbness in the ball of the foot, at the base of the toes
• Pain that may be dull, aching, or sharp and increases (rather than improves) during physical activity
• Pain that increases when you place weight on the foot, stand on tiptoe, or go barefoot
• Pain that increases, rather than improves somewhat, while walking or moving
• The feeling that you have a small stone or object underneath your foot while you are walking, even when you are barefoot

Common Causes and Symptoms of Morton’s Neuroma

Morton’s Neuroma is typically understood to be caused by an injury to the nerves in the foot, or strain and injury to the toes that is often caused by wearing high heels or other shoes that place great strain on the toes and ball of the foot. This strain and injury results in swelling, pain, and a mass of tissue that forms around the nerves in the toes. While this mass of tissue and the word “Neuroma’ can sometimes bring a tumor to mind, the mass is not a true tumor, but rather a benign fibroma. Symptoms of Morton’s Neuroma include the following:

• Tingling, numbness, and pain in the ball of foot
• A sore, tender area between the third and fourth toes on the bottom of the foot
• A slight or pronounced mass of tissue between the third and fourth toes at the ball of the foot
• The feeling that you are standing on a small pebble, or that some foreign object is beneath your skin at the ball of your foot
• Pain that improves when not bearing weight on the foot

Morton’s Neuroma Vs. Metatarsalgia

While the differences between Morton’s Neuroma and Metatarsalgia can be subtle–especially when the pain is significant and seems to radiate across the entire ball of the foot–you and your doctor will be able to distinguish between them with the following cues:

• The pain from Morton’s Neuroma will be located between the third and fourth toes, on the ball of the foot. In contrast, the pain from Metatarsalgia will generally be felt across the entire ball of the foot, where the toes meet the foot.
• Morton’s Neuroma often presents as numbness and tingling before becoming worse and developing into pain, while Metatarsalgia more often begins as a dull pain that develops into sharper pain
• In Morton’s Neuroma, you may be able to feel a pronounced mass between the third and fourth toes

Treating Pain in the Ball of the Foot

Whether you’re experiencing Metatarsalgia or Morton’s Neuroma, it’s important to work with your physician to determine the root cause before you begin a course of treatment, since both of these conditions have numerous root causes. Determining the cause while also addressing acute pain and symptoms will help you find both immediate and lasting healing and relief.
Your doctor will look and your health history, lifestyle, and habits to determine the root cause of the pain in the ball of your foot. He or she will also examine your feet and may recommend x-rays to rule out other possible complications or conditions.

Once you and your doctor have determined the cause of your pain and identified the condition you’re dealing with, the course of treatment you follow will depend a great deal on severity of symptoms. In some severe cases, Morton’s Neuroma may require steroid injections or decompression surgery to relieve pressure on the nerves in the feet and remove the affected tissue. However, for mild symptoms of both Metatarsalgia and Morton’s neuroma, there are numerous at-home treatments that can help significantly, including stretches and foot exercises to strengthen the muscles in your feet and Achilles tendon to reduce the amount of pressure on the ball of your foot, orthotic inserts that raise your arch and reduce pressure on the ball of your foot, icing regularly, eliminating unsupportive and damaging footwear from your wardrobe, and NSAIDs like ibuprofen to reduce pain and inflammation.

Most cases of Metatarsalgia and Morton’s Neuroma can be successfully resolved with conservative treatments–especially if symptoms are addressed early and consistently. If you’re experiencing pain or numbness in the ball of your foot, don’t wait for symptoms to get worse!

While we usually associate foot and heel pain with getting older, children can suffer from heel pain too.

And prompt, effective treatment is more important than ever for a growing, active child.

However, unlike adults, children may not communicate their symptoms in a way that leads you to quickly identify the problem and begin treatment.

Being aware of the common causes of heel pain in children, how those conditions may manifest themselves, effective treatments, and signs you should visit a doctor are very important for keeping your child healthy and active.

Common Causes of Heel Pain in Children

While the list below isn’t exhaustive, the following are the most common causes of heel pain in children:

Severs Disease

Severs Disease is a serious condition that causes heel pain, and is often mistaken for “growing pains.” It’s caused by the fact that a child’s heel bones grow slower than the rest of the ligaments in the legs. When the heel bone goes through a growth spurt, but the rest of the feet and legs are struggling to catch up, the result can be significant heel pain that needs medical attention right away. The condition manifests as limping, difficulty walking, swelling and redness, and intense pain.

Overuse

Kids can have seemingly endless amounts of energy–but the ligaments and muscles in their heels and feet are still susceptible to injury and wear through overuse. When too many sports practices happen back-to-back, or kids engage in physical activity in intense spurts without much warm-up, the muscles and ligaments in the foot may not be able to rest and recover from micro-injuries and wear, resulting in a compounding effect and eventual injury.

Sports

Sports are one of the most common causes of heel and foot injury for children. Any activity that involves running, jumping, or rapid changes in movement and direction puts significant strain on the arch and heels. When kids engage in sports without supportive footwear, or fail to warm up the muscles in the feet and legs properly, injury to the feet and heels is highly likely.

Stress Fractures

Whether kids play sports or not, most are on the go constantly as they explore and play. Tumbles, falls, and jumps on hard or uneven surfaces can result in stress fractures to the heel or bones in the foot. Stress fractures aren’t a complete break, of the bone, but rather tiny, painful fissures in the bone that require immediate treatment.

Plantar Fasciitis

Plantar fasciitis is the result of inflammation and damage to the arch of the foot, and causes pain in the heel and foot while walking, especially first thing in the morning. Plantar fasciitis can have many causes, but high-impact sports, overuse, and improperly fitting shoes are major culprits for kids.

Improperly Fitting Shoes

Poorly fitting shoes can result in a host of heel and foot problems for kids. Because children’s feet grow so quickly, it’s easy for shoes to become too tight in the heel or toe box. And because many children are very active, shoes often wear out more quickly than their adult counterparts, resulting in poor arch and heel support.

Symptoms of Heel Pain in Children

When children experience heel or foot pain–especially in the early stages, they may not articulate it to you, or may talk about it in vague terms. Keep an eye out for the following, so that you can address heel or foot issues early, before they become more serious:

• Complaints about shoes being too tight, or “old” may indicate footwear that’s no longer supportive, worn out, or putting too much pressure on the toes or heel
• Limping, which may be an indication of Severs Disease and should be treated right away
• Intuitively stretching or massaging the heels and feet
• Complaints of stiffness or “prickles” in the feet or heels, especially first thing in the morning
• Changes in physical activity level
• Complaints of “feeling like there is something in their shoe” even when there is nothing to be found in the shoe
• Changes in the way your child plays sports or runs/walks/jumps as they play. Look for any changes in gait, or signs that your child appears to favor their feet

Safe Heel Pain Treatments for Kids

Most of the time, heel pain in children can be treated effectively and safely at home, without the risk of ongoing or permanent damage:

Stretching

Stretching not only helps warm up and increase flexibility in the heels and feet–it also improves their strength and resilience. Strong, flexible ligaments and muscles in the feet and legs are far less likely to be injured or strained. A weak or injured arch can become healthier and stronger through consistent daily stretching.

Icing

Ice can be very helpful in reducing pain and inflammation in injured or strained heels and feet. Ice for 10-15 minutes at a time, shielding the skin from direct contact with the ice using a washcloth, plastic bag, or ice slipper.

Orthotics

Older kids and teens can fortify their shoes with orthotics to help the arch of the foot distribute and withstand the impact of play and sports. Orthotics raise the arch of the foot to an optimal height, and provide important support and cushioning.

Rest

Rest is a simple yet very important component to healing. For an active kid, this can be extremely difficult, but it’s important to help your child spend plenty of time resting their feet and heel, avoiding high impact activities, and allowing complete and proper healing take place.

When Should You Visit a Doctor?

As a rule of thumb, your child should see a doctor for heel or foot pain that is persistent, severe or comes on very suddenly. If your child is limping or having trouble walking, it’s a good idea to stay on the safe side and see a physician. When in doubt, or if you suspect Severs Disease, be sure to talk to your doctor.

While it’s true that children have small feet, they deserve just as much attention and care as big feet! By knowing which symptoms to watch for, when to visit a doctor, and which conditions are most likely to strike children and cause heel pain, you can help keep your kids’ feet healthy and strong.