Are you living with heel pain (plantar fasciitis)?
Many people go on living with heel pain and believe “it is just part of life” and the inevitable consequence of using their feet. This isn’t true. Heel pain is treatable and many times the treatment is simple, long lasting, and the relief can start quickly.
There are many possible causes of heel pain such as stress fractures, tendonitis, arthritis, or nerve irritation. Boney spurs to the heel bone can also be present but usually are not the cause of the pain. The most common cause of heel pain is plantar fasciitis.
What is Plantar Fasciiitis and its Causes?
Plantar fasciitis is an inflammation of the plantar fascia. The plantar fascia is a band or rope-like soft tissue that starts on the bottom side of the heel and runs to the toes. When this band of tissue gets overworked it becomes irritated and inflamed which causes the heel pain. The most common causes of plantar fasciitis are related to foot structure along with not having enough support for the foot. Having high arches or flat feet contribute to the stressful pulling forces on the plantar fascia that lead to the inflammation and pain in the heel and when you add long hours on your feet, unsupportive shoe gear, and hard walking or standing surfaces plantar fasciitis is a common result.
Common symptoms of plantar fasciitis to look for are sharp pains on the bottom of the heel or in the arch region which are usually worse with the first step out of bed in the morning or first step after sitting for a while. The pain will usually decrease after walking for a few minutes but then may return again and be more achy or throbby at the end of the day, especially when you have been on the feet for long hours. The pain is usually activity dependent with worse symptoms associated with increased activity level with the intensity of pain becoming worse over time. You may also see some swelling to the heel.
The good news about treating plantar fasciitis is that the pain can be resolved with conservative means approximately 95% of the time. The first line treatments are focused on decreasing inflammation, stretching, and supportive shoe gear or inserts for the foot. They include:
–Icing the heel for 15-20 minutes/hour as often as you can each day which will help reduce the inflammation. You may place an ice pack or bag of frozen veggies on your heel or freeze a bottle of water and roll it in your arch. Place a paper towel or cloth between your skin and the ice. Do not place the ice directly on the skin
–Topical and oral Anti-inflammatory medications such as Icy Hot, Ben-gay, and Voltaren gel, or ibuprofen, Advil, and Naproxen can be taken as directed by your physician to reduce the inflammation (although these are usually not nearly as effective as a cortisone injection).
-A cortisone injection is one of the most effective ways to get rid of inflammation and you will likely start feeling its effects in regards to pain relief in a day or two, although sometimes it can take up to a week.
–Calf stretches help to decrease the deforming force produced by the calves on the foot. Tight calf musculature produces an arch collapsing force which causes more tension on the plantar fascia. Use of a night splint is very effective because it allows a nice easy stretch for the calves over several hours while avoiding injury when used correctly.
–Orthotics are a great way to correctly position the foot as well as support the arch which with help decrease the tension placed on the plantar fascia and help the foot function properly.
–Avoid barefoot walking as this increase the pressure to the heel and provides no support for the arch which then increases tension to the plantar fascia.
–Resting the foot when you have plantar fasciitis is important because this will allow the plantar fascia to rest and allow your body to heal.
Most of the time plantar fasciitis is resolved with conservative treatment but in some casesconservative measures do not alleviate the pain. Surgery is indicated if the plantar fasciitis is not resolved after several months of nonsurgical treatments. The most common procedures include cutting a portion of the plantar fascia or some of the soft tissue on the back of the leg in the calf muscle or Achilles tendon region.
Although plantar fasciitis is treatable and you can have your heel pain resolved, if you do not continue to address the underlying causes long term, such as contributing foot type, tight calf muscles, unsupportive footwear, the tension to the plantar fascia may return along with the pain. For the long-term care it is important to continue with stretching of the calf muscles and utilizing proper supportive shoe gear and orthotics as well as continuing to avoid barefoot walking and flip flops.