Not a week passes by that while I am walking through the gym, I notice someone passing by who cannot put one of his or her heels on the floor.Some are women, some men, some thin and some heavy. As long as you walk, you are candidate for heel pain.
Every year, millions of Americans suffer from heel pain. By far, the majority of the cases of heel pain are caused by a condition known as plantar fasciitis (pronounced: fas-HEE-I-tis). This condition refers to the inflammation of the connective tissue that runs through the bottom of the foot from the heel bone to the front of the foot. This tissue is known as the plantar fascia. The fascia is most closely related to a tendon in appearance and texture, however, unlike a tendon there is no muscle attached to it. Due to the nature of this tissue, it is not very elastic and will get injured and begin to tear when exposed to excessive pressure. There are some factors that can make developing plantar fasciitis and heel pain more likely:
Aging. As we age, tissue breakdown becomes more prevalent. Accordingly, aging contributes to likelihood of damage to the plantar fascia.
- Poor shoe gear. Shoes that have little or no support tend to place greater strain on the fascia.
- Sports. Activity such as high impact aerobics, running and dancing can put a lot of pressure on the heel thereby causing pain.
- Poor biomechanics. Persons with high arches or flat feet are more prone to get heel pain. People with flat feet apply a greater stretching force on the fascia. When they walk, they have a greater tendency to damage the tissue by over-stretching. People with high arches have very tight fascia.This results in poor absorption of shock and allows the fascia to become injured from strain.
- Weight. There are many serious problems associated with being overweight. One of these problems is a strenuous challenge to the muscles, connective tissues and skeleton. In the heel, carrying extra weight makes the injuries that occur with poor biomechanics happen more often as well as more quickly. The excess weight also causes breakdown of the protective fat pad under the heel bone, which can result in direct injury to the heel bone and the fascia.
- Occupation. People who have to stand at work for long hours on hard surfaces are also subject to heel injury.
There are usually classic symptoms associated with plantar fasciitis. Here is a list of what you might feel if you have this condition:
- Sharp stabbing pain on the inside part of the bottom of the heel.
- The pain is usually worst first thing in the morning or upon getting up after sitting for an extended period of time.
- The pain may decrease after getting up, but the longer you are on your feet, the more the heel hurts.
- The pain may diminish during exercise, but will increase soon after.
If you have this kind of heel pain, you are not alone. As I mentioned before, millions of people suffer from heel pain every year. However, if the pain doesn’t go away in a few days don’t ignore it. Although, most cases of heel pain are plantar fasciitis there is a possibility that it could be something else and even something more serious. Some of the other conditions that cause heel pain are:
- A stress fracture of the heel bone.
- A bone cyst or tumor in the heel bone.
- A nerve entrapment behind the ankle, called Tarsal Tunnel syndrome.
- Certain types of arthritis.
- A partial or complete tear of the fascia.
Now that you know what it is, what can be a contributing cause, what it feels like and what else it might be, what can you do to help control the symptoms of plantar fasciitis?
- First and foremost, is stretching. By stretching the back of the lower leg, you will relieve the tension on the heel and subsequently relieve the stress on the plantar fascia. The most important stretches are the typical runners wall stretch. These exercises should be done throughout the day; one set per hour is ideal. Watch my YouTube video to see the stretches demonstrated. http://YouTube.com/watch?v=_sDrvbd-Ppc
- Night splints are devices that are worn to bed. They hold the foot and ankle in a position to prevent contracting of the muscle and tendon that you have been stretching all day.
- Ice massage done one or two times a day for about 10 minutes. This can be done while sitting in a chair and rolling your arch and heel on a small bottle of frozen water.
The next phase of therapy consist of oral or inject able anti-inflammatory drugs. A physical therapy regimen may be utilized to reduce the stress and strain on the fascia as well as reduce the internal swelling. At this time, custom orthotics can be fashioned to relieve the pain from plantar fasciitis.Orthotics and continued stretching are the best insurance against having a recurrence of the heel pain.
After these treatments more than 90% of patients with heel pain will have minimal or no symptoms. If you are suffering from heel pain, stretch, ice, wear good supportive shoes, diet and see your podiatrist for a complete evaluation.
What about the 10% of those who are not pain free?
See my next article on the treatment of resistant heel pain. In this article I will review PRP (Platelet Rich Plasma) injections, ESWT (Extracorporeal Shockwave Therapy), and surgery for heel pain.