Heel pain is a painful condition affecting the bottom of the foot. It is typically called plantar fasciitis. However, plantar fasciosis is more accurate when there is no inflammation but chronic degeneration instead. Acute plantar fasciitis is defined as inflammation of the origin of the plantar fascia and fascial structures around the area. Plantar fasciitis or fasciosis is usually just on one side. The pain is worse in the morning upon first stepping out of bed and will reduce after a few steps. However, as you continue to stand the pain will continue.
This article will help you understand:
- how plantar fasciitis develops
- What are the risk factors
- what can be done for your pain
As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia or bottom of the foot. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This is just how the string on a bow is stretched by the force of the bow trying to straighten. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body.
An Injury occurs as the body is no longer able to heel the injury to the fascia from either: standing all day or from over-training (running, jumping, etc). Heel pain usually comes on slowly and not all at once. You begin to notice the pain in the heel when getting up from sitting for a while or during the first step in the morning. The pain will usually go away after a short while or after you are “warmed up.” However, once the pain comes on, it is very difficult to get rid off.
People who spend a lot of time on their feet are usually plagued by heel pain at some point in their life. They will often experience this pain on multiple occasions. Nurses, service industry professionals, and runners will usually find themselves seeking relief of pain at the heel. This will, most likely, lead to time away from work or from training. In certain circumstances, people will begin a new job or initiate training and unexpectedly experience pain at their heel. This situation is one from doing too much too soon. The tissue at the bottom of the foot is not used to spending increased amount of time in weight bearing (on your feet).
Because we do not like to stop training or quit our professions due to pain in our feet, we seek out treatments that work for some but not for many others. One such treatment is the use of ORTHOTICS. These are inserts that people put into their shoes in order to provide support and prevent the fascia from stretching while on your feet. Unfortunately, most health care providers prescribe $400 dollar rigid inserts that cause more pain than you currently have. This is not economical, nor is it the correct treatment. However, over the counter gel heel cups can be magical for some folks! These are very inexpensive and will often help tremendously. This is just a bandaid! There is more to address that will help you alleviate heel pain for the long term!
We find that many times it takes a combination of different approaches to get the best results for patients with plantar fasciitis. There isn’t a one-size-fits-all plan. Some patients do best with a combination of heel padding, exercises, and stretching. If this doesn’t provide relief from symptoms within four to six weeks, then we may advise follow up with a podiatrist or orthopedic surgeon.
So, here are the do’s and don’ts:
DO: Take a little time off your feet away from work and recreation. This will allow the tissue to rest and start the repair process as you participate with specific exercises.
DON’T: Roll the bottom of your foot on a water bottle or massage ball. First, there is no inflammation so what are you icing? Second, you have tissue irritation and you do not want to further the injury.
DO: A specific set of exercises that aim to increase length of the muscles in the foot and achilles region. Please see the ones I suggest below.
DON’T: Calf stretch! If you are currently stretching and it continues to hurt, please stop! It is that easy… not all cases of plantar fasciitis will resolve with stretching. There is most likely a weakness that needs to be addressed.
I hope that the above list just turned everything you thought about treating heel pain upside-down! We have done too much of the same old stuff for too long and we now know why it didn’t work out very well.
Here is where you can start:
- Try to perform a heel raise on one foot for at least 10 times. Do this to both legs and see if it is more difficult on the side of the heel pain.
- Pick up a pencil, marbles, or scrunch up a towel up on the ground and then repeat it about 10 times.
- Sit on a chair and cross the involved leg across your knee. Pull your big toe backwards and try to “stretch” your foot and toe backwards for about 10 seconds and do this about 3-4 times.
If you need a more detailed or specific list of exercises, be on the look out for videos of how you can manage your plantar fasciitis on your own at home. If the pain in your heel has increased to the point of severe pain, it might be time to see a medical professional to make sure there is not something else happening!
Take care and keep moving!
Mike the PT
