HEEL PAIN – Plantar Fasciitis

By Dr. Brian K. Bailey, Podiatric Physician & Surgeon –

Do your first few steps out of bed in the morning cause severe pain in your heel?
Or does your heel hurt after jogging or playing tennis?

HEEL PAINMost commonly, heel pain is caused by inflammation of the plantar fascia— the tissue along the bottom of your foot that connects your heel bone to your toes. The condition is called plantar fasciitis (PLAN-tur fas-e-I-tis).

Plantar fasciitis causes stabbing or burning pain that’s usually worse in the morning because the fascia tightens (contracts) overnight. Once your foot limbers up, the pain normally decreases, but it may return after long periods of standing or after getting up from a seated position.

In most cases, you can kick the pain of plantar fasciitis without surgery or other invasive treatments. And you can take steps to prevent plantar fasciitis from recurring.

Signs and Symptoms
Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. Plantar fasciitis can affect both feet, but it usually occurs in only one foot at a time. Watch for:
• Sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot
• Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe
• Heel pain after long periods of standing or after getting up from a seated position
• Heel pain after, but not usually during, exercise
• Mild swelling in your heel

Causes
Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. But, if tension on that bowstring becomes too great, it can become irritated or inflamed. The causes of plantar fasciitis can be:

Physical activity overload. Plantar fasciitis is common in runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially if your training regimen increases more than 10% in a week. Housework, such as moving furniture or large appliances, can trigger the pain.

Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.

Diabetes. Plantar fasciitis occurs more often in people with diabetes and metabolic syndrome because their bodies are in an inflamed state. This inflamed state can be cured with my healing diet.

Faulty foot mechanics. An arch that collapses causes an abnormal pattern of walking that adversely affects the way weight is distributed when you’re on your feet, putting added stress on the plantar fascia, bones and nerves of your feet.

Improper shoes. Shoes that are thin-soled, loose, or lack arch support or the ability to absorb shock don’t protect your feet. If you regularly wear shoes with high heels, your Achilles tendon—which is attached to your heel—can contract and shorten, causing strain on the tissue around your heel.

Risk factors
Your risk of developing plantar fasciitis increases if you are:
Active in sports. Activities that place a lot of stress on your heel bone and attached tissue are most likely to cause plantar fasciitis. This includes running, dancing and aerobics.

Flat-footed or have high arches. People with flatfeet may have poor shock absorption, which increases the stretch and strain on the plantar fascia. People with highly arched feet have tighter plantar tissue, which also leads to poor shock absorption.

Middle-aged or older. Heel pain tends to be more common with aging as the arch of your foot begins to sag, putting stress on the plantar fascia.
Overweight. Carrying around extra pounds can break down the fatty tissue under the heel bone and cause heel pain.

Pregnant. The weight gain and swelling that accompany pregnancy can cause ligaments in your body—including your feet—to relax. This can lead to mechanical problems and inflammatory conditions.

Working on your feet. People with occupations that require a lot of walking or standing on hard surfaces, including factory workers, teachers and waitresses, can damage their plantar fascia.

Wearing shoes with poor arch support or poor heel control. A closet of poorly designed pumps, loafers and boots can mean plantar problems.

When to Seek Medical Advice
If you have heel pain, try self-care measures, such as stretching and changing your activities. If you don’t see much progress after a few weeks of home treatment, see your foot doctor (podiatrist).

Seek help sooner if your pain worsens, despite home treatment. If you have diabetes or another condition that causes poor circulation, see your doctor for an early evaluation of any changes in your feet.

Screening and diagnosis: Your doctor will ask you about your symptoms and look for points of tenderness in your foot. This can help rule out other causes of heel pain, such as tendonitis, arthritis, nerve irritation or a cyst. Your doctor may also suggest an X-ray, Ultra sound or MRI to make sure you don’t have a stress fracture or tumor.

Sometimes, an X-ray shows a spur of the bone projecting forward from the heel bone. In the past, bone spurs were often blamed for heel pain and removed surgically, but doctors have found that they’re typically not the cause of pain. Surgery to remove spurs is rare.

Complications: Ignoring plantar fasciitis may result in a chronic condition that hinders your regular activities. You may also develop foot, knee, hip or back problems because of the way plantar fasciitis changes your walking motion. When your feet hurt you hurt all over.

Treatment
If self-care techniques don’t help, your doctor might suggest other treatments to heal your heel.
Conservative treatment: In my practice 99% of my patients get better with conservative treatment. Non-surgical treatments that usually promote healing include:

Low Dye Strapping is the best method for relieving tension on the plantar fascia and calming the inflammation. Tape is applied in a special way to prevent the arch from collapsing. If this works, which it does most of the time, then, a properly prescribed and made pair of orthotics will give permanent relief.

Orthotics. Quality generic orthotics not Dr. Scholl’s help the majority of patients. Some may need custom-fitted orthotics, which are specially molded to your feet, to help distribute pressure to your feet more evenly and control excess pronation. These must be made from fiberglass casts and not by stepping in a box of foam. These must be functional orthotics that allow a prescribed amount of pronation and not just an accommodative orthotic.

Night splints. Your doctor may recommend wearing a splint fitted to your calf and foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight so that they can be stretched more effectively.

Swedo braces. Support the arch with three straps and laces to limit pronation to allow healing.

Physical therapy. I often train my patient in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilizes their ankles and heel. I may also teach your significant other to apply athletic taping to support the bottom of your foot.

Anti-inflammatory diet, I give my patients a diet and list of natural supplements that naturally calm inflammation. A side effect is weight loss.

Surgical or Other Procedures
If conservative treatment doesn’t provide relief, you might consider:
Corticosteroids. When other treatments don’t work, I may suggest an injection of corticosteroid medication into your foot to calm the inflammation once the arch is supported. Multiple injections aren’t recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone.

Ultrasound applied for 20 minutes will speed up the healing process, it is as effective as shots.

RX pain creams. Voltaren gel or a compounded pain cream quite often relieves the pain and inflammation.
Surgery. Only a small percentage of people need surgery to detach the plantar fascia from the heel bone (plantar fasciotomy). It can be a simple 10 minute procedure that may be done in the office under local anesthesia. It requires one stitch and three to four days of minimal walking. A post-op shoe is worn for two-three weeks after surgery. It’s generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.

Prevention
Maintain a healthy weight. This minimizes the stress on your plantar fascia. Choose supportive shoes. Give stilettos the boot. Also avoid shoes with excessively low heels. Buy shoes with a low to moderate heel, good arch support, heel control and shock absorbency. Don’t go barefoot, especially on hard surfaces.

Don’t wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you’re a runner, buy new shoes after about 600 miles.

Start sports activities slowly. Warm up before starting any athletic activity or sport, and start a new exercise program slowly.

Wake up with a stretch. Before you get out of bed in the morning, stretch your calf muscles, arch and Achilles tendon by reaching for your toes and gently flexing your foot. This helps reverse the tightening of the plantar fascia that occurs overnight.

Self care
Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 to 20 minutes three or four times a day or after activity. Try ice massage. Freeze a water-filled Styrofoam cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation.

Decrease your miles. You probably won’t have to permanently retire your running or walking shoes, but it’s a good idea to cover shorter distances until pain subsides.

Take up a no or low-impact exercise. Swap resistance training swimming or bicycling for walking or jogging. You’ll likely be able to return to your regular activities as heel pain gradually improves or disappears.

Ask your podiatrist which shoes are best for your foot type. (606) 324-FOOT

Try acupressure techniques. Apply pressure to your heel by rolling a golf ball or tennis ball with the arch of your foot, while you are standing and stabilized. This can help reduce pain and increase blood flow.

Use over-the-counter pain medications. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others), naproxen (Aleve) and others may ease pain and inflammation, although they won’t treat the underlying problem. Use as directed, tapering off as your pain decreases.

Stretch your arches. Simple exercises using household objects can stretch or strengthen your plantar fascia, Achilles tendon and calf muscles.

Body-Mind-Spirit Podiatric Center
500 14th Street, Ashland, Kentucky, 41101
Phone (606) 324-FOOT

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