HEALTH TALK: Got pain in your heels?

If your first few steps out of bed in the morning cause severe pain, or if your heel hurts after jogging, you may have a real problem.

Most commonly, the pain is caused by inflammation of the plantar fascia – the tissue along the bottom of your foot that connects your heel bone to your toes. The condition: PLANTAR FASCIITIS.

Plantar fasciitis causes stabbing or burning pain that is usually worse in the morning because the fascia tightens overnight. The pain usually decreases as your foot limbers up, but it may return after standing for a long time or after getting up from a seated position.

The pain of this condition can be dealt with without surgery or other invasive methods. And you can keep it from recurring.

SIGN AND SYMPTOMS

The condition usually comes on gradually, but can occur suddenly and be severe. It can affect both feet, but often occurs in only one foot at a time.

Symptoms include:

•    Sharp pain in the inside part of the bottom of your heels which may feel like a knife sticking in the bottom of your foot.
•    Heel pain that tends to be worse with the first few steps after awakening, climbing stairs or standing tiptoe.
•    Heel pain after standing long periods or after getting up from sitting.
•    Heel pain after, not during, exercise.
•    Mild swelling in your heel.

CAUSES

Normally, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. But small tears can be created in the fascia if tension on that bowstring becomes great. Repeated stretching and tearing can cause the fascia to become irritated or inflamed.

Causes of the condition include:

•    Physical activity overload. It’s common in long-distance runners. Jogging, walking or stair climbing can also place too much stress on the heel bone and the soft tissue attached to it, especially when starting an aggressive exercise program. Even household exertion, such as moving furniture or large appliances, can trigger the pain.

•    Arthritis. Some types cause inflammation in the tendons in the bottom of your foot, leading to fasciitis.

•   Diabetes. We don’t know why, but plantar fasciitis occurs more often in diabetics.

•  Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal walking pattern, can adversely affect the way the weight is distributed when you’re on your feet, putting added stress on the plantar fascia.

•    Improper shoes. Thin-soled, loose shoes or ones which lack arch support or the ability to absorb shock don’t protect your feet. If you’re a wearer of high-heeled shoes, your Achilles tendon – which is attached to your heel – can contract and shorten, causing strain on the tissue around your heel.

RISK FACTORS

Developing plantar fasciitis is more likely if you are:

•  Active in sports. This may put a lot of stress on your heel bone and attached tissue. Included are running, aerobics, and ballet dancing.

•    Flat-footed or have high arches. Flat feet may have poor shock absorption, increasing the stretch and strain on the plantar fascia. Arched feet have tighter plantar tissue, which also leads to poor shock absorption.

•  Middle-aged or older. Heel pain tends to be more common with aging, because the arch of your foot tends to sag more, putting stress on the plantar fascia.

•    Overweight. Carrying around extra pounds can break down the fatty tissue under the heel bone and cause heel pain.

•    Pregnant. With this comes weight gain and swelling that can cause you body’s ligaments, including you foot ligaments, to relax. Mechanical problems and inflammatory conditions can result.

•    Being on your feet. Certain occupations demand this, such as teaching, working in a factory, or being a waitress. Damaging your plantar fascia is more common in these cases.

•    Wearing shoes with poor support or stiff soles. Using a lot of poorly designed pumps, loafers, and boots can lead to plantar problems.

COMPLICATIONS

Chronic pain that limits your regular activities is one. You may also develop foot, knee, hip or back problems because of how plantar fasciitis changes your walking motion.

TREATMENT

CONSERVATIVE TREATMENT
For most people, the condition improves within a year of starting conservative treatment. Non-surgical treatments that may assist healing include:

•    Night splints. This is a splint fitted to your calf and foot while you sleep, holding the plantar fascia and Achilles tendon in a lengthened position overnight so they can be stretched more effectively.

•    Orthotics. These are arch supports you can buy to help distribute pressure to your feet more evenly.

•    Physical therapy. Exercise to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, as well as to stabilize your ankle and heel, can help. A therapist can also teach you to apply athletic taping to support the bottom of your foot.

MEDICATIONS AND PROCEDURES

When conservative treatments aren’t effective, doctor may consider:

Corticosteroids. One or two injections of this kind of medication, such as Prednisone, into the region of the plantar fascia attachment at the heel, provides temporary relief. Multiple injections should be avoided because they can weaken your plantar fascia and even cause it to rupture, as well as shrink the fat pad covering the heel bone.

Extracorporeal shock wave therapy. Sound waves are directed at the area of heel pain to stimulate healing. It’s usually used for chronic cases unresponsive to conservative treatments. This is not used for children, pregnant women or people with a history of bleeding problems.

Surgery. A small number of suffers need surgery to detach a plantar fascia from the heel bone (plantar fasciotomy). This is an option only when the pain is severe and all else fails. A side effect is weakening of the arch in your foot.

See you next week.

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5 Comments

  1. Anonymous
    July 4, 2013

    :lol: 8-O :-? :-D

  2. outside looking in
    May 4, 2011

    Dr Emanuel!
    Thank you so very much for describing that pain Ive been feeling for the past 2 weeks. I am a 66 yr old female, exercises twice a week, but 2 weeks ago I started doing some step exercise, and the next day, my heels were on fire. The balls of my feet hurt so much that i started limping, I agree with all the causes you stated as well as symptoms. I am thinking of getting an instep for my sneakers, but i have discontinued that particular type of exercise. Thanks again

  3. ur patient fan base
    May 4, 2011

    Doc,
    There is an article here on legalizing “mary jane” Your feedback would be very much appreciated.
    You can be indirect if need be and say these ideas are not those of the doc just being devil’s advocate. You are a sound guy so shoot man without fair of political contamination.

  4. MaryMary
    May 4, 2011

    I have this problem. I was pregnant, then had a miscarriage and my podiatrist said that it was because of the weight gain. He advised me to lose the extra pounds and wear NB sneakers. I also bought the Scholl’s inserts for arch support and feel better. I just want it to go away permanently.
    Great article, once again, doc!

  5. COACH
    May 4, 2011

    Dr. I realized you never mentioned the cortizon injection. What are the side effect of these type of treatment if any.
    Good piece of information sharing I need to read more often your column….

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