Help heel pain

Rising in the morning, you put your feet on the floor and immediately feel a sharp pain inside your heel. Or after exercising your heel aches and swells. Or your heel hurts anytime you stand up after sitting for a while.

These pains are typical of plantar fasciitis, a common foot condition. It’s caused by the inflammation of the fibrous tissue that runs along the bottom of your foot. This fibrous band of connective tissue is the plantar fascia that attaches your heel to your toe bones (see diagram). Although it’s not dangerous, plantar fasciitis can curtail your activities and alter your gait, which can cause foot, knee, and back pain.

Some other causes need to be ruled out, including pain due to a pinched nerve in your back or at the level of the ankle or foot, a stress fracture, or chronic conditions, such as inflammatory arthritis. But in most cases, pain on the bottom of the heel is due to plantar fasciitis. The plantar fascia has a lot to do with supporting your foot. It acts like a shock-absorbing bowstring that supports the arch and keeps the foot from collapsing. The trouble comes if there’s too much tension placed on your foot’s “bowstring.” The result can be microscopic tears in the fibrous plantar fascia tissue, inflammation and piercing pain, or an aching or burning sensation in the heel. Usually, the problem is gradual, affecting only one foot.

Pain is usually worst in the morning. Those first steps can be excruciating because the plantar fascia has had a chance to tighten up during the night while the foot was relaxing. Typically, as the foot limbers up, the pain becomes less. Other telltale signs include:

• Heel pain following long periods of standing, if you’re climbing stairs or standing on your tip toes.

• Heel pain after exercise but not usually during exercise.

WHY ME?

Plantar fasciitis can affect people of all ages. Overuse may be the cause among highly active teens and people in their 20s and 30s. People who are less active and then suddenly become active or start an athletic program are at greater risk. It can be more common in middle-aged or older adults. As the plantar fascia loses some ability to stretch, the fat pad protecting the heel thins and the foot becomes less shock-tolerant.

Excessive weight can also place more stress on your feet. Other factors that may influence your risk of dealing with plantar fasciitis include:

•Improper shoes.

Improper footwear may include shoes with soles that are thin or lack shock absorption, have poor arch support or are loose around the heel. In addition, avoid regularly wearing two-inch or higher heels. These can cause contraction of the Achilles tendon that runs up the back of your heel, and then switching to a flatter shoe increases strain on the tissues around the heel, possibly affecting the plantar fascia.

• Overloading your feet.

Activities that regularly keep you on your feet for an extended time can increase your risk. So does lifting heavy objects. In addition, making a sudden change in the amount of weight-bearing activities you do — such as walking more than usual while on vacation — ups your risk of plantar fasciitis.

• Stressing the foot due to mechanics.

An abnormal walking pattern that interferes with the even distribution of weight may place added stress on the plantar fascia. Having flat feet may also make you more likely to develop plantar fasciitis. The same is true if you have high arches, which can result in tightening of the plantar fascia and poor shock absorption.

In addition, some forms of inflammatory arthritis, such as rheumatoid arthritis, may first show up as tendon inflammation. These conditions usually occur simultaneously in both heels and can be identified using a blood test.

Self-Help Steps

Patience and persistence are needed to give the plantar fascia a chance to heal. In addition to losing excess weight, try:

• Daily stretches.

Stretching increases the flexibility of the plantar fascia (see diagrams). Do some stretches before getting out of bed in the morning to help reduce pain with your first steps. Stretch several times a day and wear a night splint so that you don’t lose the benefit of those stretches.

Stretching your Achilles tendon is often recommended for additional pain relief; however, directly targeting the plantar fascia may have better results. A study published in The Journal of Bone and Joint Surgery evaluated 82 chronic plantar fasciitis patients who were given a three-week supply of celecoxib (Celebrex), orthotics, and instructions for an Achilles tendon stretch or a plantar fascia stretch. After eight weeks, participants who stretched their plantar fascia felt less pain and could perform more activities than patients who stretched their Achilles tendon.

When the study ended, the plantar fascia stretch was taught to all participants. Two years later, 66 of the original patients were re-examined; 94 percent of these patients reported feeling no pain or less pain than they had experienced before the study, and only 30 percent had undergone further treatment with a physician or physical therapist.

• Cooling your heel.

Soaking your heel in cold water may help. Or apply a cloth-covered ice or gel pack for 15 minutes, especially after an activity. However, if you have diabetes, neuropathy or poor circulation, talk with your physician before using cold (or heat) therapy.

• Wearing appropriate shoes.

Low- to medium-heeled shoes with no more than one- to two-inch heels with good support and shock absorption are best. Replace your shoes regularly. There are also a variety of shoe inserts such as heel cups, insoles, and arch supports that may help. If possible, avoid walking barefoot.

In addition, you may find that nonprescription pain relievers such as ibuprofen (Advil) and others may ease some of the pain and inflammation.

Other Treatment Options

If self-help measures aren’t providing relief with time, it may be necessary to try other forms of treatment. One option is to use a night splint. There is an adjustable boot that can be worn while you sleep. It keeps the foot at a 90 degree angle to the leg, preventing the plantar fascia from contracting and healing in a shortened position.

Physical therapy is useful. Ultrasound may be utilized to deliver deep heat to the bottom of your feet, increasing blood flow to promote healing. Other techniques involve applying topical anti-inflammatory medications to the heel area followed by electrical stimulation (iontophoresis) or ultrasound (phonophoresis). If these measures fail, your doctor may consider using a cortisone injection. In some instances, a cast or walking boot is recommended to completely immobilize the foot over a period of five to six weeks. If conventional therapies fail to relieve the heel pain, other more aggressive options, including extracorporeal shock wave therapy, which uses high-energy shock waves, or surgery may be considered. Whether shock wave therapy is beneficial for most people with this problem is still being debated. And the notion that heel spurs cause plantar fasciitis and therefore should be surgically removed is no longer valid. Many people with heel spurs have no heel pain. And many people with plantar fasciitis don’t have heel spurs. Thus, surgery is rarely necessary for this condition because other less invasive treatments are usually effective. Yes, there is help available for your heel pain!