Has your heel been hurting? Are you having trouble getting up out of the bed in the morning because of pain? Do your feet feel tired at the end of the day or are you having difficulty running and exercising? You may be suffering from plantar fasciitis. Plantar fasciitis is the most common cause of heel pain seen at Prairie Path Foot and Ankle Clinic. The worst thing to do is wait more than a week to start addressing this and/or make an appointment. Plantar fasciitis results from strain on the ligament that runs along the arch of the bottom of the foot. If treated early on and aggressively, this condition does NOT have to become a pain that haunts you time and time again over your years of activity. By aggressive, we do not mean surgically. In fact, 98% of cases of plantar fasciitis do not require surgical intervention. This article will give you the keys to treating plantar fasciitis conservatively and successfully. Some of the recommendations you will read below are simple things you can do at home, and in cases where these methods are initiated early on you may not need the intervention of a podiatrist right away.
The key is to understand the causes of plantar fasciitis. By addressing these underlying causes, we can help get rid of heel pain for most people in a matter of weeks. Plantar fasciitis the term is describing that there is inflammation of the plantar fascia ligament on the bottom of the foot. Therefore, inflammation is one part of the issue. The reason why this inflammation presents is typically overuse of the ligament, which some people are more prone to than others due to their foot structure. You may have initiated activities too quickly or activities may have been the same, but the support of your foot was lacking (think about going to Great America in Old Navy flipflops). In order to address the overuse and lack of support, we address the mechanics at play in plantar fasciitis. Typically, there is tightness of the plantar fascia as well as the achilles tendon. There are many different foot structures that can put additional strain on the plantar fascia, but supporting your arch is a must when treating plantar fasciitis.
To address the inflammatory component of plantar fasciitis, we recommend icing and often times oral anti-inflammatories. These are keys to treating plantar fasciitis, though they will not be successful on their own. As stated earlier, we need to still correct the mechanical component.
To help the plantar fascia recover and heal appropriately, a stretching regimen is important. This will help to loosen the tight tendon and ligament so that they can function more normally during your activities. In plantar fasciitis that has been going on more than a few weeks, stretching also helps to facilitate reorganization of the scar tissue that your body has formed in efforts to toughen up the ligament under the heel. For many of our patients, pain is the worst when first getting out of bed in the morning as well as when getting up from sitting for a prolonged period of time – or even after driving. This is called post-static dyskinesia. As your body continually tries to heal the damaged tissue near the heel, collagen fibers are laid down. When seated, sleeping and driving, our foot is usually pointed downwards which places the plantar fasciia in a shortened position. If collagen fibers are continually laid down for a long period of time, then upon rising, all those collagen fibers are stretched again very quickly and the inflammatory process continues. Our office recommends a particular device called a night splint. There are many on the market, but the one we offer has been found to be most comfortable for our patients and has demonstrated superior improvement in heel pain. This device is placed on the foot with use of straps that hold the ankle in a more neutral position, so that you are essentially stretching as you rest and while the body is continuing to heal the ligament.
To address the mechanics of your foot structure, we recommend a temporary arch strap which supports the foot while you are walking and active throughout the day. These straps are not meant to last forever, but rather are useful in the first month of your treatment plan. Once your heel pain has either resolved or greatly improved, the use of custom orthotics is of the utmost importance. These are inserts that slide into your shoes and have a semi-rigid material to support the arch of your foot and hold you in an optimally functioning position. As these inserts are custom, they are fit to your foot with specifications made to position your foot appropriately and we can also customize the size, shape and materials that will best fit the shoes you are active in the most. Don’t be put off by the term semi-rigid either. When orthotics are fitted correctly, you will notice the support but after a brief break-in period the support will feel good enough that when you aren’t wearing your orthotics, you will wish you were! These inserts also most often are covered with a slightly cushioned material – another reason you won’t feel like you are walking on something hard.
If your heel has been hurting and you think you have plantar fasciitis, you can start with a few of the above therapies on your own. Icing can be done with an icepack or a bag of frozen peas. We recommend applying the ice over a sock to the area of pain 3 times daily. If you haven’t been told by your PCP to avoid NSAIDS, ibuprofen can be taken to reduce inflammation. What you might not realize is that taking anti-inflammatories for an active condition in your feet is that unless there is a contraindication to the medicine, the anti-inflammatories should be taken regularly for about 3 weeks. Some people may perceive an improvement in pain enough that they don’t think the anti-inflammatories are necessary after a few days or a week. However, some amount of inflammation may be subclinical – meaning it may still be there even if you aren’t feeling the pain.
Another thing to start at home is a solid stretching regimen. Just like with icing, 3 times daily is optimal for this. Looking up achilles tendon or plantar fascia stretching online (or look no further than our website) is simple enough. Finally, to support your feet better, you may or may not have access to arch straps or arch padding. However, as is true with any tendinitis or fasciitis in the foot, a couple weeks in an athletic shoe (at home and while out) can do wonders to restore your foot back to it’s happier and less painful state.
Pain in your heel that comes about after an injury or pain that has not improved with a week or two of diligent home therapies should be evaluated by a professional. If you need help managing your heel pain, call our office for an appointment. You don’t have to live with heel pain, it is not just a part of getting older! There are so many things we can do to get you back to your activities and life without pain.