I had previously published this article in our patient newsletter Aches & Joints.
If you are a runner, you probably worried about Plantar Fasciitis. Early in the summer when researching this article, I got a mild case of heel pain that left me distraught. My training for the Boston Half Marathon (Oct 7th 2007) was guarded and I am still tentative with my heel. But doing all the exercises linked at the end, I am good to go.
What you can do to reduce heel pain
Heel Pain Can Be Debilitating
“Getting out of bed each morning was painful,” recalls a patient of her yearlong experience with heel pain. “As I place my foot on the floor, I could feel a sharp pain in my heel and could only shuffle about the room. It would loosen up after a few minutes, but my foot would continue to hurt as I went through the day.”
Heel pain with the first steps getting out of bed in the morning, or when standing from a seated position, are the most characteristic symptoms of plantar fasciitis (fashee-eye-tiss). Pain can also occur with prolonged standing and walking. The sharp pain is usually on the bottom inside part of the heel. While it most often occurs in only one foot, it can affect both feet.
Plantar Fasciitis Causes Heel Pain
The plantar fascia is a tough, fibrous tissue band running under the soles of your feet, and connects the heel bone (calcaneus) to the base of the toes. It also helps support the arch of the foot in its role as a shock absorber. An injury or continuous irritation of this tissue causes plantar fasciitis and the resulting heel pain.
Multiple factors likely cause plantar fasciitis. It tends to affect people between 40 and 70 years of age, more likely in women, people who are overweight, or have jobs that require a lot of walking or standing on hard surfaces. Runners may be at a higher risk. People with flat feet or high arches are also more prone to plantar fasciitis.
The following self care measures may help reduce symptoms.
- Stop all impact sports and rest the foot.
- Stretching the plantar fascia and Achilles tendon is effective in reducing symptoms. (see effective exercises at the end of this post)
- Use shoes with better heel cushioning, or include a heel cup for pain relief.
- Apply ice to the heel. Freeze a plastic bottle of water and roll your foot over it.
- Limited use of nonsteroidal anti-inflammatory medications (e.g. ibuprofen or naproxen) is helpful.
- Different types of day or night wear splints keep your plantar fascia stretched, and relieve pain.
Day wear splints can be worn with regular shoes. They keep the heel stretched and provide pain relief throughout the day.
A night splint worn to bed keeps the plantar fascia stretched while sleeping and can prevent early morning heel pain.
In the vast majority, plantar fasciitis will resolve itself within three to six months, but in some patients it can take a year or more. When symptoms fail to improve after 4 to 6 weeks of home treatment, see your doctor or foot specialist.
If heel pain is accompanied by unusual symptoms such as back pain, burning in the foot, or recent trauma, see a specialist. In case of severe and persistent pain that has not responded to conservative treatments, your doctor may prescribe a removable walking cast. This will keep your foot immobile for a few weeks, to allow it to rest and heal. Other treatments include ultrasound therapy directed at the area of heel pain, or even cortisone injections.
Surgery As Last Resort
Only a tiny percentage of people undergo surgery, which includes detaching the plantar fascia from the heel bone. “Surgery should be the last resort when all other treatments have failed, and the pain remains severe for over a year,” insists Dr. Richard de Asla, Co-Director of the Foot and Ankle Service at the Massachusetts General Hospital and Instructor of Orthopaedic Surgery at Harvard Medical School, Boston, MA.
“We rarely operate on this condition because in most patients the pain resolves on its own with time. Furthermore, the surgical success rate is only about 70% with the potential for other complications,” reminds Dr. de Asla.
Exercises to treat heel pain: