Heel pain is so commonly seen within the profession of podiatry that there are some podiatrists marketing so-called "heel pain clinics" now-a-days. As you can find on our website, there are a lot of causes of heel pain other than plantar fasciitis, but plantar fasciitis is the most common. This condition can present in a variety of foot structures and can start for a variety of reasons. Initial treatment can be done at home, but if heel pain due to plantar fasciitis isn't improving after a few days, it is imperative to seek additional resources - like your local podiatrist!
When patients come in for initial evaluation of heel pain, some cannot recall any change in their activities or a specific injury recently. Others may relate that they recently changed their exercise routine or began an exercise program and had not been exercising much prior to that. Some patients will relate that they had a very busy day, few days or a couple of weeks when they were on their feet more. Yet others relate that their heel pain began after they began gaining weight (around the holidays in some cases)!
Why exactly does increased activity initiate this process? It all comes down to the structure of your foot and how it functions while walking. Whether your feet have high, low, or 'normal' arches (your overall foot type), most people have some degree of flexibility and lose some of the natural arch support while standing. There are muscles and tendons in the leg and foot that help support the arch. The plantar fascia is a ligament on the bottom of the foot that also supports the arch. When a person is on their feet for prolonged periods of time, the muscles supporting the arch of the foot become fatigued, stretched and the arch collapses, putting strain on the plantar fascia.
Often times the plantar fascia can develop small tears within the bands of tissue because of being over stretched. It is for this reason that many people have pain with the first few steps after sitting for a prolonged period of time or in the morning after a night of sleep. While sitting or sleeping, the arch can return to a more anatomical position and the plantar fascia is functionally shorter than while standing. In this relaxed position for a period of time, your body tries to repair the small tears that occurred while walking and when you then stand again, the scar tissue that has begun to set is quickly torn again.
The two targets of treatment for plantar fasciitis include inflammation and poor biomechanics (or the structure of your foot). Inflammation is the root cause of pain in the heel, as your body tries to repair damaged tissue in the plantar fascia. The inflammation can be reduced with the use of icing (external anti-inflammatory) and oral anti-inflammatories (internal). However, the key to keeping the plantar fascia from becoming inflamed again is to reduce the risk of damage by supporting the structure of the foot and decreasing the predisposition of the arch to flatten out while standing and walking. This is initially addressed with the use of a rest strap, made custom to the foot on the first visit. Once the acute phase of plantar fasciitis has resolved, a more permanent form of arch support is required in the form of an orthotic insert. Stretching is another component of treatment and is necessary to gain flexibility and elasticity in the arch in order to prevent tearing of the plantar fascia. Active stretches are a great way to start, but many people also require passive stretching in the form of a splint that holds the foot in a neutral position. This means that any healing overnight can occur without causing a shortening of the plantar fascia.
Another important point to discuss is heel spurs. Heel pain is still commonly referred to by many of our patients as heel spurs. Years ago, it was very common to remove a heel spur in the presence of heel pain. The origin of heel spurs (we call them inferior calcaneal exostoses) is the strain of the ligament where it meets the heel bone. Bone in the body grows in reaction to tension and compression. In the case of plantar fasciitis, the pulling of the ligament constantly stimulates extra bone growth on the heel bone. The heel spurs are not commonly removed today because it has been found that in a majority of cases the pain is stemming from the ligament, not the bone. The reasons for taking x-rays when dealing with a probable plantar fasciitis are many. However, the presence of the spur more serves to tell us how long the poor biomechanics have been affecting the plantar fascia and this helps us to understand whether remedying the situation will take weeks or months.
If you have heel pain that hasn't improved over the course of a week, try stretching and icing. If you aren't getting relief after a few days, visit us at Prairie Path Foot & Ankle Clinic for a thorough assessment and further guidance on how to get rid of this irritating condition!