Painful heels are the number 4 concern bringing patients into the offices of many family doctors and the number 1 concern bringing patients to the offices of podiatric physicians (foot doctors).
Heel pain can have many causes, but the vast majority is caused by plantar fasciitis. Plantar means, “bottom of the foot.” Fascia is a ligament or “bundle” of ligaments. The plantar fascia is the thick ligament that helps to hold up the foot and provide spring in our step.
Plantar fasciitis, pronounced (PLAN-tar FASHEE-itis) is an inflammation of the plantar fascia and causes more than 90% of heel pain among adults in the US.
Plantar fasciitis can be acute, that is, as a simple strain of the ligament but often is chronic, hanging on for months if not years. Why does that happen? The answer is poor foot mechanics, the foot sinking down too far allowing the plantar fascia to overstretch with each step taken.
If the plantar fasciitis is acute, that is, a sprain of the plantar fascia then it is basically treated as a sprain, with anti-inflammatory drugs, ice, rest, possibly physical therapy. If chronic, poor foot mechanics need to be addressed.
Foot mechanics are changed by the use of specially molded shoe inserts known as orthotics. Someone with plantar fasciitis needs an orthotic designed to relieve strain on the plantar fascia. Orthotics are often confused with arch supports. Arch supports, by holding up the arch can remove some tension from the plantar fascia. Orthotics, on the other hand, do most of their work on the heel and ball of the foot repositioning the foot for maximized function.
What can you do before you see the foot doctor? First, try doing your own version of deep tissue massage by rolling a frozen cola bottle or can from the heel forward into the arch. Do it gently. Do stretch but the key to good stretching is not to stretch too hard so generally avoid weight-bearing (standing) stretches but sit on a soft surface like your bed and pull the foot backward on the leg as far as it will go, holding for 20 seconds and relaxing for 5 seconds.
Each 25-second “set” can be repeated 5 times, and you have invested about 2 minutes in giving yourself a lot of help.
Watch out for the shoes you wear. It is tempting to obtain shoes that are colorful and soft. Here is the proof that soft shoes are bad. Wrap a pillow around your foot with duct tape and walk for a block or two. You will come back with your foot hurting more because your foot sank down deeper into the soft surface, allowing the ligament to stretch more. The shoes should be stiff in the shank and flexible at the ball. Such shoes, to running buffs, are known as motion control shoes or stability shoes so going to one of the small specialty running shoe stores is a good place to start.
If you don’t have a desk job or have an industrial job see if light duty is available. A note from your doc may be all that is required in most cases and most doctors are happy to oblige.
Orthotics, by treating the cause of the problem, lead to the cure better than 90% of the time. Some patients have waited so long that the plantar fascia has become thickened and filled with scar tissue and are not helped by “conventional” means. Those are the patients that have, traditionally, required surgical treatment in which the plantar fascia is cut off the heel bone. Luckily, most surgery has been replaced by a relatively new mode of treatment, ESWT, or Extracorporeal Shockwave Therapy. ESWT involves the application of multiple shockwaves to the diseased tendon or ligament and has an approximately 85 to 90% success rate. Keep in mind we are talking about this success rate in patients who are “tough cases,” that are already had the conventional treatment.
The ESWT machines look like miniature renal lithtripsors (kidney stone crushers). There are virtually no side effects to ESWT other than the price as only about 30% of insurance companies are paying for it. They realize that it is less costly and safer than surgery but also know that many more people who would avoid surgery would have no problem getting ESWT so the volume of services would go up.