There are many different causes of heel pain, but the most common cause is plantar fasciitis (plan * tar fash* ee * I * tis). If you experience a sharp pain in your heel when you first step down in the morning, it is most likely due to plantar fasciitis. This problem is a result of excess stress through a long ligament type structure (the plantar fascia) in the bottom of the foot. The excess stress causes tearing and results in inflammation and pain. The classic symptoms are pain in the heel at the first step in the morning, or upon rising after long periods of rest. Many will complain of a sharp pain in the heel when they step out of their car or after finishing their lunch break. Other individuals only experience heel pain at the end of the day or during certain types of activity like running, soccer or tennis. The pain may extend into the arch and feel achy at the end of the day.
Individuals develop plantar fasciitis for a variety of reasons. One of the most common reasons for the development of plantar fasciitis is wearing poor quality or worn out shoes. Another common reason is starting a new activity, such as walking or running, after a period of inactivity. Many active individuals develop plantar fasciitis after incorporating hills, stairs or uneven terrain into their training routine. A new job that requires standing all day or switching to a job with a harder surface, like cement floors, may contribute to it’s development. Individuals with flatfeet or excess pronation (rolling in of the feet) may have a natural predisposition for plantar fasciitis. Regardless of how the problem started, the treatment is aimed at decreasing the stress on the arch and decreasing the inflammation.
1. Identify the cause: There is usually a reason for the development of plantar fasciitis, but since the condition is not typically associated with an acute injury it may be hard to remember. The pain may have gradually developed after starting a new training routine, changing the routine, running or walking on a new surface, switching shoes, wearing worn out shoes or starting a new job. Once the cause is identified, stop the activity or modify it.
2. Avoid aggravating activities: Going up and down stairs, walking or running on hills, squating, lifting heavy items and walking on uneven terrain all aggravate this condition. Try to decrease these by limiting the number of times you go up and down the stairs and avoiding hills. If you must squat down, keep the affected foot in front and flat on the ground. Do not lift or carry heavy items including your kids. Use a stroller or have your spouse, significant other or friend carry them.
3. Stop running or walking: Aerobic activity is important to maintain and cross training can help. Try biking or swimming. Most walkers hate the stationary bike at the gym, but remember this isn’t forever. Don’t drop your heel when you bike and try to avoid standing and hills if you cycle outdoors. If you participate in spin classes, you may need to modify the class to avoid further injury to the foot. The recumbent stationary bike may place excess stress through the arch because of the position. The classic stationary bike is more appropriate.
4. Use an ice massage: Freeze a sports water bottle or a juice can and place it on the floor. Roll your foot over the water bottle for at least 20 minutes twice a day. This helps decrease the inflammation in the foot while stretching out the arch.
5. Use a contrast bath: Icing helps decrease inflammation occurring within a 48-72 hour period. To help decrease chronic inflammation, try contrasting between ice and heat. Start with an ice pack on the heel and/or arch for 5 minutes. Switch to a heating pack or a hot water bath for 5 minutes. Alternate between the two for 20- 30 minutes 3-4 times a week. This may be more time consuming than the ice pack alone, but can bring considerable relief.
6. Roll a ball under your foot: Take a tennis ball, soft ball or even a rolling pin and roll your foot over it to help stretch out the plantar fascia. This can be done while watching TV or reading the paper. Rolling the foot over the tennis ball can also be done at work if you have a desk job or during a lunch break. (This should not cause pain. Don’t continue if you have pain).
7. Stretch your calf in the morning: If you have pain in the morning upon waking, place a towel or a belt on your dresser. Before you get out of bed, wrap the towel or belt around the ball of your foot. By pulling the foot towards you and keeping your leg straight, you should feel a stretch in the back of the calf. This will also stretch the bottom of the foot. This is not time consuming or difficult to do, but it does require adjusting to a new routine.
8. Stretch your calf throughout the day: Spend about 5-10 minutes each evening stretching the calf as described above or with the runner’s stretch. To really help keep the calf and the bottom of the foot stretched out, try and stretch for 30 seconds, 10 times a day.
9. Take anti-inflammatory medications: Anti-inflammatory medications, like naproxen or ibuprofen, will help decrease the inflammation that occurs in the fascia as a result of the tearing. You don’t want to mask the pain with these medications. If you decrease the pain with the anti-inflammatory medications but continue to participate in an activity which causes tearing and inflammation of the plantar fascia, you are not healing. Continue resting, icing and stretching while you take the medications. Take the medication with food and stop taking the medication if you experience stomach discomfort.
10. Lose Weight: This is probably the last thing you wanted to hear. In fact, there is a good chance that you have gained some weight since the onset of your heel pain due to a decrease in activity. But, there is no way around the fact that increased weight on the body transmits to the feet. Increasing the stress on the plantar fascia can worsen plantar fasciitis, making it more difficult to treat. Eat smart and try to incorporate aerobic activity which decreases the impact on the feet.
11. Wear supportive shoes: This step may seem logical, but most individuals don’t realize how many shoes lack support. A supportive shoe will only bend at the toes. Test all of your shoes and don’t assume your running shoe is a supportive shoe. Take your shoe and flip it over. Grab the toe area and the heel and try to fold the shoe. If the shoe bends in half, then the shoe is not supportive. Don’t go barefoot. Get up in the morning, do your stretch and then slip your feet in a supportive slipper or clog. See the American Podiatric Medical Association’s (APMA) list of approved shoes at www.apma.org/ seal/sealaccategory.html.
12. Try anti-fatigue mats: These mats help to decrease the stress through the heel and add some shock absorption to the floor. The mats can be a great asset for employees who work on a hard surface. You may want to consider them for home if you spend many hours standing in a workshop or in the kitchen. See the APMA’s list of approved anti-fatigue mats at www.apma.org/ seal/sealaccategory.html.
13. Strengthen the muscles in your feet: Place a thin towel on your kitchen floor. Place your foot over the base of the towel closest to you. Bring the towel towards you by curling the toes and gripping the towel as it slides under your foot. Place marbles on the floor and pick them up one by one with your toes and place them in a bowl.
14. Wear orthotics: Prefabricated orthotics are semi-rigid inserts that fit into the shoe to help control motion in your feet. Controlling abnormal motion in the feet can decrease the stress in the plantar fascia. Soft inserts available at the drug store may be comfortable, but they will not help control abnormal motion.
15. Try a night splint: A night splint holds the foot at 90 degrees while you sleep. This keeps the foot and the calf stretched out all night long. Night splints are an effective treatment, but can be quite uncomfortable. Some individuals have more luck with the sock night splints than with the rigid splints. These devices are available online, but may be covered by your insurance when dispensed by your doctor.
If your symptoms persist, see a podiatrist.
