Policeman’s heel, is also known as plantar fasciitis, policeman’s foot, or a sprained heel. Technically, the term “sprained heel” is actually a misnomer, as you can’t sprain a bone; however, the heel is the attachment site for the plantar fascia, and as such, the pain associated with policeman’s heel can feel similar to a sprain, so it’s understandable why people often call it a sprained heel.
Policeman’s heel is a debilitating condition that can affect anyone who spends a reasonable amount of time on their feet. It’s actually very common, especially among middle-aged men and women; however, just because it’s common doesn’t mean it should be ignored. This article will discuss some of the most common policeman’s heel symptoms, the associated anatomy and physiology, and common treatment strategies to reduce pain.
What is policeman’s heel?
Policeman’s heel refers to heel pain caused by dysfunction within the plantar fascia, such as irritation, inflammation, tearing, and/or general disorganization of the collagen fibers that make up the plantar fascia. The plantar fascia is a thick band of tissue on the sole of the foot running from the heel to the forefoot.
This fascia is passive fibrous tissue, meaning it cannot be actively contracted like a muscle, and as such, relies purely on its material properties to sustain the forces placed upon it. When the plantar fascia is irritated or damaged, it is most common to feel this pain on the anteromedial aspect of the heel bone (calcaneus), or in other words, the front part of the bottom of the heel bone closer to the inside of the foot.
What causes policeman’s heel?
Policeman’s heel can result from a variety of different factors (Trojian and Tucker, 2019), which makes it important to have a thorough assessment performed by a doctor or physiotherapist in order to guide future treatment strategies.
Some lifestyle factors that can put someone at greater risk of developing policeman’s heel include long periods of time standing, walking, or performing long distance running on hard surfaces, especially on a daily basis. These factors can be amplified if the same individual has poor medial arch support in the foot, or if their activity levels were increased more abruptly rather than gradually.
So why do these factors, which are typically healthy things to do, lead to the diagnosis of policeman’s heel? Given the plantar fascia is a passive tissue that doesn’t have quite the same blood supply as a muscle, it takes longer to remodel itself to the demands placed on it.
If this is combined with other mechanical factors that increase the stress on it, such as poor footwear, reduced ankle and foot strength, and previous injuries, then the plantar fascia is now more prone to being over-stressed, which ultimately leads to the typical heel pain and inflammation that people feel.
Policeman’s Heel Treatment
Conservative treatment is typically advised before seeking more invasive medical procedures such as steroid injections, and rarely do clinicians recommend surgery for policeman’s heel, as this is typically considered a last resort for those experiencing severe pain for a long period of time.
The most conservative form of treatment for the diagnosis of policeman’s heel would be rest, but this is rarely successful in abolishing heel pain long term, therefore the strategies listed below will usually offer the most effective self-management strategies.
Policeman’s heel treatment can take a variety of forms. Finding the right shoes can sometimes be challenging and expensive, so using arch supports (shoe inserts) and custom orthotics in your current shoes can help in the short term, as well as rolling and stretching the plantar fascia tissue, while also ensuring your symptoms do not become worse.
Good arch support can be important for people who over-pronate, which will help prevent the medial arch from collapsing with each step, ultimately reducing the amount of stress placed on the plantar fascia. Those who experience plantar fasciitis pain for an extended period are often advised to wear shoes with good arch support and avoid high heels if possible.
Rolling the affected foot over a frozen water bottle can help with pain and inflammation in the heel bone. You can also use something more aggressive like a golf ball, which can also help reduce policeman’s heel symptoms. While orthotics and stretching can be fairly effective strategies, but they may not represent effective long term strategies especially in moderate to severe cases, which means we need to dig deeper to get to the source of the problem.
Policeman’s Heel Exercises
A physiotherapist is one of the more reliable healthcare professionals to seek help from for this condition, as they can identify biomechanical factors influencing someone’s plantar fasciitis pain that can be corrected through therapeutic stretching, strengthening, and motor control training.
In other words, if someone’s foot and ankle moves in way that places too much stress on the plantar fascia, a physiotherapist can provide ways to reduce the stress by providing more support from surrounding muscles.
Policeman’s Heel Exercises – Stretching
We briefly mentioned that stretching the plantar fascia can help alleviate policeman’s heel symptoms (Boonchum et al, 2020). Generally speaking, the main way to do this is to dorsiflex the ankle (toes to nose) and gently extend the big toe (i.e. lift up the big toe) which should provide a sensation of stretch to the bottom of the foot, especially along the medial aspect of the sole of the foot.
This can be done in a sitting or standing position. In sitting, you can use your hands to help provide the stretch. In standing, you can perform a standard calf stretch, but with the added component of creating a lift under the big toe, such as a door wedge or a folded cloth. This type of stretch is often termed a “Windlass stretch”.
The calf muscle is also an effective muscle to stretch for policeman’s heel. The soleus and gastrocnemius, which are the two main calf muscles, both blend into the Achilles tendon that inserts onto the back of the heel. This tendon insertion is in very close proximity to the origin of the plantar fascia. You can actually achieve a stretch of both muscles by using the strategy mentioned above, which involves stretching the calf while also lifting up the big toe.
Policeman’s Heel Exercises – Strength and Stability
Strengthening is one of the most effective way to achieve a long term solution to policeman’s heel pain (Thong-On et al, 2019). In many cases, strengthening is aimed at muscles that help support the medial arch of the foot, as well as muscle that assist in preventing over-pronation of the foot and ankle joints.
The primary muscles that help to actively support the medial arch of the foot include tibialis posterior, flexor hallucis longus, tibialis anterior, and the smaller foot intrinsic muscles that are scattered over the bottom of the foot.
Tibialis posterior is one of the primary dynamic supports that helps maintain the medial arch of the foot and is informally termed the “core of the lower leg”. This muscle sits deep to the calf muscle and performs much of the same action, but also performs ankle inversion. Its tendon wraps behind the medial malleolus of the tibia, passes by the heel bone to insert on the navicular bone, but then also continues to insert on multiple points on the bottom of the foot and toes. Therefore, in addition to plantarflexion and inversion of the ankle joint, contraction of this muscle will help prevent excessive pronation of the foot and ankle.
Tibialis anterior sit on the front of the shin and is the main muscle the performs ankle dorsiflexion. Similar to tibialis posterior, this muscle’s tendinous insertion point is on the inside of the foot (medial cuneiform and base of 1st metatarsal), and as such, also has a secondary action of ankle inversion. Therefore, by way of its action and insertion point, this muscle can also help support the medial arch of the foot when contracted.
Flexor hallucis longus, which crosses under the foot and attaches to the bottom of the big toe, also support the bottom of the foot, albeit a little more weakly. It helps stabilize the big toe during weight acceptance and toe-off during walking and running, which can help take some of the load off the plantar fascia while also aiding in proper biomechanics.
The foot intrinsic muscles are different from the muscles previously mentioned as they don’t originate higher up in the leg. These muscles span single joints in the foot, or smaller areas of the foot, and help provide more specific joint stability. They are usually strengthened as a unit to help provide support to the plantar fascia.
Overall, activity-based treatment that places a focus on strength and support of these muscle groups represents one of the most effective ways to treat policeman’s heel, especially when looking for long-term solutions and prevention of recurrence.
Adjuncts to Exercises
In addition to the strategies listed above, a physiotherapy clinic can often add a little more to the treatment by offering adjuncts to activity-based treatment. An adjunct refers to something used in a treatment session that isn’t a priority, but can help assist with the recovery process especially in the short terms.
Dry needling is an adjunct that is often employed in clinical settings. This technique involves the use of an acupuncture needle. Depending on the style of dry needling performed, the needle may be inserted into a plantar fasciitis trigger point, or it may be used on completely different muscle groups, such as the glutes, to assist in alleviating any symptoms that may have developed up the chain (e.g. hip pain due to altered walking mechanics). This technique can help facilitate pain reduction both in the short-term and long-term phases of the recovery process (Llurda-Almuzara et al, 2021).
Shockwave therapy is also a very common adjunct to treatment for policeman’s heel. This is a machine that delivers a targeted shockwave in the form of acoustic waves to the affected area at a high frequency. For example, a shockwave machine can be set to deliver thousands of pulses of pressure over the course of a few minutes, while the clinician moves the device over the plantar fascia. This therapy can help to enhance blood circulation to the area, regenerate damaged tissue, break down scar tissue, and decrease pain around the heel bone (Leao et al, 2020).
Policeman’s heel is a condition that can affect anyone who spends lots of time on their feet or has experienced a sudden increase in activity-levels on their feet. The recovery timeline will vary depending on severity and task demands of the individual, but by combining activity-based treatment with other modalities, one can ensure they recovery as soon as possible and develop strategies to prevent future occurrences.
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