Heel pain

      
        

Heel pain caused by plantar fasciitis is a very common foot problem.
Pain will occur upon arising in the morning or when standing up after prolonged sitting.  The plantar fascia is a strong fibrous band of tissue that originates in the heel and runs toward the ball of the foot. The plantar fascia helps to stabilize the arch. The problem begins when there is stress applied to the plantar fascia due a foot fault or instability.  Plantar fasciitis can result from your arch collapsing while you walk as the heel lifts off the ground.  This leads to the foot muscles in your arch trying to resist this arch collapse along with the plantar fascia.   When the heel lifts off the ground the foot bends and twists in the middle and causes stretching in the plantar fascia. The stretching of the plantar fascia over time can lead to micro-tears in the plantar fascia. The micro-tearing can occur anywhere along the length of the plantar fascia. The plantar fascia will be become inflamed as it pulls away from its insertion point located underneath the heel bone or calcaneus.  Over time as the plantar fascia pulls away from the heel bone at its attachment site it can cause a bone spur to form on the heel bone.   The heel spur is a secondary X ray finding and is not the real problem.   If left untreated plantar fasciitis can become chronic and becomes more difficult to treat.  It is difficult to rest the foot because every step you take will stretch the plantar fascia and aggravate the problem. This problem can progress rapidly and needs to be addressed as soon as possible before it becomes a chronic problem.

Causes or predisposing factors leading to plantar fasciitis

  • Tight calf muscle

  • Flat feet

  • Excessive foot pronation

  • High arched rigid feet

  • Irritation of nerves leading into the heel area

  • Excessive weight

  • Poor footwear

  • Overuse caused by new exercise regime

  • Increasing age

Management of plantar fasciitis

Rest

Resting the injured site is a very important part of the treatment to help to reduce the stretching, bending and twisting on the plantar fascia.  At the very least you must modify you activity.  Exercise must be put on hold.

Shoes

Shoes are very important aspect in the recovery of plantar fasciitis.  Athletic footwear provides  support to help heal the plantar fascia.  The shoe must have firm heel counters,  extra heel cushion,  torsional support and laces to provide support and balance.

Taping

Taping the arch of the foot will stabilize the foot and arch. The tape is applied daily. Taping will provide short term relief by reducing the stretching, bending and twisting on the plantar fascia. Custom foot orthotic therapy is indicated if short term taping is successful.

Calf stretching

Gentle stretching of the calf muscle will reduce the tension in the calf muscle which in turn reduces stress on the plantar fascia.

Ice Massage

Pressing ice in a circular motion into the heel for about 10 minutes will help to break down any scar tissue where the plantar fascia attaches to the heel bone.

Muscle strengthening exercises

There are several exercises that help to strengthen the small muscles of the foot. This will help to reduce some of the strain on the plantar fascia.  Some of the exercises that are prescribed include towel curls, tennis ball roll, shin curls and toe grabs.

Anti-inflammatory medication

Topical or oral anti-inflammatory medication can be prescribed to reduce the inflammation in the plantar fascia.

Heel pads

Soft gel cushion heel pads can help to absorb the shock as the heel strikes the ground. Some heel pads have softer material centrally to further cushion the insertion site of the plantar fascia.

Laser/ultrasound therapy

These treatments can control pain and aid the healing process.

Manual foot treatments

These treatments involve the realignment of the boney structures via osteopathic manipulations around ankle, rearfoot and midfoot. This improves blood flow and lymphatic drainage. This is very useful dealing with very stiff and tired feet.

Custom Foot Orthotics

Prescription foot orthotics are custom made orthopedic devices that help to realign your feet and reduce any abnormal compensations due structural foot abnormalities. These structural foot abnormalities over time will cause flat feet or excessive foot instability causing tearing of the plantar fasciitis. The prescription foot orthotic is molded from a semi rigid to semi flexible thermoplastic material. The orthotic will have a deep heel cup, a cushioned sweet spot at the bottom of the heel cup, a contoured arch profile to take as much pressure off the heel. The foot orthotic will usually have full length top cover to prevent the orthotic from moving around inside the shoe.

Night splints

Night splints are used at night.  The night split keeps the foot at a 90 degree angle which keeps the plantar facia and calf muscle elongated throughout the night. This will help to reduce the intial painful stretch of these structures in the morning upon standing.  The night splint is usually prescribed for about 4-6 weeks.

Corticosteroid injection

A localized injection of a corticosteroid into the area of the plantar fascia bone attachment site in the heel can break the cycle of inflammation and pain.  It is important to realize  a corticosteroid injection is not a cure for the problem. It does not address the cause of the of the pain.

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