The Good Life

Have you ever had a sharp pain in your heel when you get out of the bed in the morning and you think you must have overdone it the day before? That pain could very well be more than just too much activity. It could be a medical condition called plantar fasciitis, which is one of the most common
causes of heel pain.

Plantar fasciitis is caused by inflammation of the plantar fascia, which is the tissue or ligament that runs across the bottom of the foot connecting the heel to the toes. The plantar fascia acts as a natural shock absorber for the foot and supports the arch. When the tension becomes too great the tissue develops small tears, which with continued strain and tearing leads to irritation and inflammation. This inflammation causes a stabbing pain in the heel area that most often occurs when an individual first gets out of bed. The pain usually decreases when the foot loosens up; however, may it recur if the affected person stands for long periods or gets up from a sitting position. The condition usually progresses gradually and most often only affects one foot, although it is possible for both feet to be affected at the same time.

Factors that may increase risk include: age, it is most common between ages 40 and 60; gender, women are more often affected than men; obesity; exercises that cause increased stress on the heel such as running and dancing; occupations that require a lot of walking or standing on hard surfaces such as nurses, teachers, and waitresses; wearing improper shoes that lack arch support
or shock absorption; and things that cause an abnormal walking or standing pattern such as being flat footed or having a high arch.

Individuals should consult their family doctor, who may in turn refer them to a specialist. The doctor will perform a physical exam to check reflexes, muscle strength and tone, sensations, and areas of tenderness of the foot or ankle. Your doctor will more than likely initially order an x-ray to determine if there are any other issues with the bones such as stress fractures or bone spurs that could be causing the pain. Once they get those results they will probably recommend a magnetic resonance image (MRI) to ensure there is not a pinched nerve or other cause.

Once your doctor determines you have plantar fasciitis he will recommend an appropriate treatment. Treatment may include nonsteroidal anti-inflammatory drugs, also referred to as NSAIDS. These are medications that can be purchased over the counter such as ibuprofen (Advil, Motrin) and naproxen
(Aleve). These will ease the pain and inflammation but will not treat the underlying cause. Another type of medication that your doctor may prescribe is corticosteroids, which can be administered topically (on the skin) and absorbed with the aid of mild electric currents at the site of pain. They can also be given in the form of injections into the affected area; however, multiple injections can contribute to a weakening of the ligament and may cause it to rupture.

Approximately 90 percent of people affected recover in a few months with conservative treatment. A physical therapist can teach you exercises to stretch the ligaments and tendons in your foot and to strengthen your leg muscles to help maintain stabilization of the ankle and heel. Other treatments
may include wearing a splint on your foot while sleeping, which will hold the ligament and tendon in the lengthened position; wearing an orthopedic shoe or boot until the area heels; or using an arch support in your shoes to help distribute pressure.

There are some things you can do at home to help with the pain and inflammation. First, stay off your feet for several days when the pain is severe. Use ice on the area for 15 to 20 minutes at a time 3 to 4 times a day or after any activity. You may also use a frozen water bottle and roll it over the
painful area for 5 minutes, which is referred to as ice massage. When used on a routine basis ice massages can be very effective. Decrease your activity or substitute lower impact activities during periods of exacerbation. Wear supportive shoes or add arch supports to your shoes. Avoid high heels. Do not go
barefooted. Change your athletic shoes frequently to avoid wearing worn out, unsupportive shoes during exercise and activity.

Use stretching exercises to stretch the plantar fascia, Achilles tendon, and calf muscles. These exercises should be held for at least 30 seconds 2 to 3 times a day and include the following:

• Place a towel on the floor and using your toes pull it toward you to aid in strengthening your arch muscles.
• While sitting grab your toes and pull them up toward your chest until you feel stretching in the arch of your foot. Only do one foot at a time.
• Stand facing a wall. With both hands flat on the wall straighten one leg out behind you with the heel down then move your hips forward until you feel your calf muscles stretching.    Switch and do with your other leg as well.
• Stand on a bottom step and put your weight on the ball of your foot. Slowly lower your heel until you feel your calf muscle stretch. Change and repeat on other side.

For those individuals with chronic plantar fasciitis that is not responding to conservative treatments, more extensive treatments are available. These include extra corporeal shock wave therapy, in which sound waves are directed to the area of pain to stimulate healing. This may lead to numbness or tingling, bruising, swelling, and pain. This treatment is not effective on a consistent basis. The other treatment is surgery. Only a small number of people need surgery and it’s usually an option only when the pain is severe and all other treatments fail.

If plantar fasciitis is left untreated it can lead to a chronic foot, knee, hip, or back problem due to the way it affects or alters your walking motion. So, if you are having chronic foot pain schedule an appointment with your healthcare provider.