Almost everybody eventually experiences the dreaded heel pain. In most podiatry offices, 95% of all plantar heel pain cases are diagnosed as plantar fasciitis. This type of pain is worst right when you get out of bed in the morning, sometimes feeling like there’s a bruise on the bottom of your heel or even a sharp pain, as if a nail is going into the bottom of your heel. Plantar fasciitis is the most common issue seen by podiatrists. The plantar fascia is a soft tissue structure that starts at the bottom of the heel bone and extends distally, attaching to all five toe joints. It is not very stretchable or flexible, similar to a rope—we can wiggle a rope, but we can’t really stretch it. This condition is primarily observed in individuals in their fourth and fifth decades of life. At this stage, tissues in our body have started to change; we've become less flexible and less elastic, but we're still very busy with family, work, and exercise. Some individuals may also have put on a few extra pounds, which doesn't help with this issue.
What plantar fasciitis really involves is an actual tear of the tissue where it attaches to the plantar heel bone. Once it's torn, the body responds with a massive inflammation response, causing swelling and pain, and it’s hard to get better on its own because we’re on our feet every day, using each foot equally. Podiatrists often explain to patients that if the same thing happened in the wrist, one could rest that wrist and use the other to perform most daily tasks. With the foot, we can't do that; we need each foot equally to walk.
Main Treatment Options for Plantar Fasciitis
Activity Modification
Any musculoskeletal injury needs rest to heal. Podiatrists recommend putting on hold any weight-bearing exercise such as walking, running, or jogging. Golfing, tennis, dancing, cycling, or stationary biking, and swimming or upper body exercises are fine.
Supportive Shoes
While podiatrists support exercising the muscles of the foot and making our feet strong when not in pain, an injury needs to be immobilized temporarily, and this is best done with the proper shoe. They recommend a shoe with a firm, sturdy sole that flexes only at the toe box where the toes need to bend. Another important feature is the heel counter, the back of the shoe, which should be rigid to stabilize the heel bone. If the heel bone is stable, the whole foot is stable. Lastly, laces, as opposed to slip-ons, buckles, or Velcro, provide a better fit, which means better support. Think of this shoe as a brace for the injury.
Arch Support
Every step we take causes our arches to fall, a process called pronation, our built-in shock absorber. When our arches fall, it puts a strain on the plantar fascia, pulling it away from the heel bone. Arch support will hold up the arch and prevent that collapse, which will rest the plantar fascia instantly. Podiatrists consider it an absolute must inside your shoe to heal plantar fasciitis.
Ice
As simple as it sounds, ice can reduce the inflammation that has built up in the bottom of the heel. Chronic inflammation interferes with healing, so it is recommended to remove that inflammation safely with 10 to 15 minutes of ice, two times a day.
Stretch
Stretch your calf muscle. The calf muscle is connected to the Achilles tendon, which attaches to the back of the heel bone and then continues under the heel bone to form the plantar fascia; essentially, it's all one piece. As mentioned earlier, the plantar fascia isn’t very stretchable, but the muscle is. Daily stretching of the calf muscle is recommended to keep the entire system loose, as any system under tension is more vulnerable to injury.
Night Splint
As the name implies, a night splint is something you wear at night while sleeping. When we sleep, our foot is in a relaxed or plantar flexed position. Your body will take advantage of being off your foot for seven or eight hours and start to mend the tear. As soon as we stand up in the morning, all our body weight suddenly goes through the foot. The foot moves 90° to the leg, and the tissue that has just been repaired over the last seven or eight hours, while you were sleeping, gets strained again, causing the dreaded morning pain. A night splint will hold your foot and leg together while you sleep; when you stand up in the morning, you won’t undo all the healing from the prior eight hours.
Implementing these measures will give a good start to getting your plantar heel pain managed. If you do not respond within a couple of weeks, it is advised to make an appointment with your.
Written by
Dr. Jeffrey S. Hurless
DPM, FACFAS Board Certified Foot & Ankle Surgeon/Podiatrist
Medical Director, HealthyFeetStore.com
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