Heel Pain/Heel Spurs/Plantar Fasciitis

What is Plantar Fasciitis?

The most common cause for heel pain is plantar fasciitis. This condition is classically known for causing pain in the heel at the first step in the morning. The pain can be so severe that many will limp, or grab onto a wall to make their way to the bathroom. After thirty minutes or so, the pain tends to work itself out. Although this is the classic description of plantar fasciitis, it is not the only presentation of this condition. Some individuals will only experience pain in their heel when they run, walk or hike. Others will only experience pain in the arch after long periods of standing. Many people will complain only of pain in their heels at the end of a long workday. Classic descriptive terms for plantar fasciitis include stone bruise, sharp dagger, deep throbbing and dull ache. These all represent plantar fasciitis type pain. Another name for this condition is “heel spur syndrome.”

Plantar fasciitis is the tearing and inflammation of the plantar fascia, which is along ligament type structure on the bottom of the foot. This is a result of small microtears in the fascia, usually due to overuse. A spur can develop thus the traction force from the fascia, but the heel spur is rarely the cause of pain.

Why does plantar fasciitis happen?

Most people have abnormal motion in their feet, usually pronation. When the feet turn in and collapse, excess stress is placed on the plantar fascia. It only takes a small change in activity or change in shoes to cause microscopic tears in the plantar fascia. A change in activity could be running more on hills or starting the soccer season. But, it commonly occurs when walking in a pair of poor quality shoes, such as flimsy sandals or an old pair of gardening shoes. Even working at a new job on your feet or on a new type of surface in a new type of shoe can easily contributes to the development of microscopic tearing in the plantar fascia. Plantar fasciitis is not a condition that develops after working on your feet for years. In fact, someone working at a desk job for 25 years, who switches to a job on their feet, is much more likely to develop the problem. Once the fascia is weakened, it tears more and then it becomes more inflamed, and then tears more. The constant weight of the body on the feet puts a tremendous force load through the feet. Think of how many steps you take throughout the day on your feet. Think of how many steps you take on your feet in the morning before you leave for work. Each step is on an injured foot. When the foot is injured, the injury becomes worse with each step. A vicious cycle develops. This makes the condition very difficult to treat.

What You Can Do To Treat Plantar Fasciitis?

The treatments for plantar fasciitis are usually conservative. The following are the most important treatments you can do:

1) Decrease your activity.

Stop running, jogging or walking for exercise. Try biking or swimming. Avoid hills and minimize walking up and down stairs. Try not to carry any heavy items.

2) Ice massage your arch and heel.

Fill a sports water bottle with water and when frozen, place on the floor and roll your foot over it for 15 minutes at least twice a day. This will ice massage the arch, decreasing inflammation along the plantar fascia. Another option is to ice directly on the heel with an icepack for 15 minutes, two to three times a day. The more icing the better. Icing 10+ times a day in the initial stages of plantar fasciitis will accelerate healing.

3) Stretch! Stretch! Stretch!

This is one of the most important treatments. Try to stretch your calf and bottom of your foot multiple times throughout the day.

4) Try heel lifts or heel cups.

In combination with the above therapies mentioned, heel cups and heel lifts can be beneficial.
Heel lifts take pressure off of the Achilles tendon and calf muscle, which will decrease the stress through the arch and on the plantar fascia. Try at least a ¼ inch heel lift. Any type will work, but foam seems to be the most comfortable, but felt doesn’t compress as easily. A wedged heel or small high heel shoe will also accomplish the same thing. For individuals with very sore heels, for those who complain of their heel feeling like a “stonebruise”, heel cups can provide relief. Heel cups generally work best in the early phases of plantar fasciitis when the heel is very inflamed and very tender. After this period, heel cups are generally not beneficial.

5 ) Place orthotics in your shoes.

Orthotics are not insoles. Insoles are generally soft and cushy supports which slip into the shoe and add comfort and cushion.