Ouch - My foot!

Dr. Keith Card, Podiatrist

Straight talk about Plantar Fasciitis

Have you been ignoring that nagging heel pain that has you hobbling all the way to the shower in the morning? Most heel pain is the result of tearing or damage to a ligament called the plantar fascia. The most common symptom is pain on the bottom of the heel or into the middle portion of the foot. The pain is most intense after periods of rest such as sleeping or sitting for a prolonged period of time. The pain generally eases or resolves with activity such as standing or walking but may return after several hours of continuous activity. In severe cases the pain does not ease with movement.

The medical term for pain on the bottom of the heel is plantar fasciitis. This term comes from the anatomical name of this particular ligament, The Plantar Fascia and itis, which means inflammation. The bottom of the foot is called the plantar surface much like the palmar surface or palm on the hand. Fascia is the Latin word for band and is used to describe broad and thin sheet-like connective tissue. In this case the fascia is similar to a ligament in that it connects the heel bone to the bones of the toes. So to make a long story short, plantar fasciitis is “inflammation of a broad but thin ligament on the bottom of the foot.”

The inflammation and subsequent pain is caused when the plantar fascia is strained beyond its limits and the tissue fibers begin to tear. As you walk or stand your body weight is transferred down the leg to the top of the arch-shaped bones of the foot. This force without the fascia would tend to cause the arch bones to collapse. If the force through the fascia is stronger than the fibers can withstand, the fascia will begin to tear. This can occur due to carrying heavy weights, shock loading the feet such as in running or jumping, or standing and walking for long periods until the muscles of the legs and feet begin to fatigue resulting in more force being transferred to the plantar fascia. This tearing occurs most frequently where the plantar fascia is at its narrowest point attaching to the heel bone. Frequently a“bone spur” forms at the attachment to the heel bone. This spur is formed by a process of tearing and healing over a long period of time. The spur is not typically a cause of the pain but rather a sign that the damage has been ongoing.

Treatment for plantar fasciitis is generally straightforward but is often frustratingly slow. The most important thing is to strengthen the plantar fascia to the point that it can easily handle the stress that you put on it. This is typically done through a long process of exercises and stretches to strengthen and facilitate elasticity in the fascia until it no longer tears with use. An ice pack or a frozen bottle of water to the bottom of a barefoot can reduce inflammation and speed the healing process. Oral anti-inflammatory medications may ease the pain for a period of time but typically is not sufficient to solve the problem of the tearing. Shoe inserts may also help ease the forces to the plantar fascia by helping to support the arch.

If your pain is severe or not alleviated with the above self-treatments you should see your doctor to confirm the diagnosis and initiate more aggressive therapy. Patient-specific exercises or physical therapy may be required to sufficiently strengthen the fascia. A night splint or boot-like device that is designed for wear at night may be prescribed to facilitate stretching. Prescription medicines or even a steroid injection may ease the pain for a period of time until sufficient strength is achieved in the plantar fascia. Custom made shoe inserts and weight loss can also reduce the strain on the plantar fascia leading to a reduction in symptoms. A walking cast may be prescribed in severe cases.

The surgical treatment of plantar fasciitis is generally done after months of failure of the above treatments. Because heel pain is caused by tearing of the plantar fascia rather than the presence of the bone spur, removing a spur without strengthening the plantar fascia will not solve the problem.

If you are experiencing heel pain like described above, here are some simple tips you can try: 1. Stop going barefoot and throw away old or worn-out shoes. 2. Apply an ice pack to the painful area after activities. 3. Do some stretching in the morning even before getting out of bed and before exercise. Movements that stretch the calf muscles are most helpful for heel pain. 4. Take a few days of rest from strenuous activities if possible. 5. Many foot cushions or arch supports sold in stores can be helpful but are not usually adequate to fully resolve the pain. Ask your doctor which ones may be right for your foot or if you need prescription arch supports. When foot discomfort occurs, early treatment usually results in the best chance for complete healing and a speedy return to your regular activities. Call your doctor if these tips do not get you gliding painlessly into your morning routine.