| Arch or Heel Pain |
General Information |
If you have pain under your heel, after sitting or sleeping and starting
to walk, but it gets better as you walk around, you probably have
plantar fasciitis. This is a painful inflammation of the ligament
that runs along the bottom of foot, between the ball of the foot and
the heel. |
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How does it occur? |
There are several possible causes of plantar fasciitis, including
:
• wearing high heels, loafers or flats without support
• gaining weight
• increased walking, standing,
or stair-climbing
• starting a new exercise without proper
training techniques
• tight heel cords.
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If you wear high-heeled shoes, including western-style boots, for
long periods of time, the tough, tendon-like tissue of the bottom
of your foot can become shorter. This layer of tissue is called the
plantar fascia. Pain occurs when you stretch fascia that has shortened.
This painful stretching might happen, for example, when you walk barefoot
after getting out of bed in the morning. |
Runners may get plantar fasciitis when they change their workout and
increase their mileage or frequency of workouts without appropriate
build-up of training. Shoes that aren’t replaced often enough
can also cause an irritation of this ligament as will a change in
an exercise surface or terrain. |
If the arches of your foot are abnormally high or low, you are more
likely to develop plantar fasciitis than if your arches are normal.
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What are the symptoms? |
The main symptom of plantar fasciitis is heel pain when you start
to walk. This pain typically occurs first thing in the morning after
you get out of bed, when your foot is placed flat on the floor. The
pain occurs because you are stretching the plantar fascia. The pain
usually lessens with more walking as you stretch out the ligament,
but you may have it again after periods of rest as the body tries
to repair the injury and it is reinjured each time you start to walk.
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You may feel no pain when you are sleeping because the position of
your feet during rest allows the fascia to shorten and relax. |
How is it diagnosed? |
The diagnosis is usually a clinical one through questioning and pushing
on the area of pain. An x-ray of your heel may be done to rule-out
other causes of heel pain such as arthritis, cyst formation in the
heel, fractures, etc. |
How is it treated? |
Give your painful heel lots of rest. You may need to stay completely
off your foot for several days when the pain is severe. |
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We may recommend or prescribe anti-inflammatory medications, such
as aspirin or ibuprofen. These drugs decrease pain and inflammation.
Resting your heel on an ice pack for a few minutes several times a
day can also help. |
Try to cushion your foot. You can do this by wearing athletic shoes,
even at work, for awhile. Heel cushions can also be used, but support
is usually more beneficial. The cushions or supports should be worn
in both shoes. |
An orthotic arch support, specially molded to fit your foot, may be
part of your treatment. These supports can be particularly helpful
if you have flat feet or high arches. You can tell if that is what
is needed when short-term taping decreases your heel pain. |
If your heel pain is not relieved by the treatments described above,
your health care provider may recommend physical therapy. The goals
of physical therapy are to stretch the plantar fascia and to strengthen
the lower leg muscles, which stabilize the ankle and heel. |
Sometimes we dispense a splint may be fitted to the calf of your leg
and foot, to be worn at night to keep your foot stretched during sleep.
Another possible treatment is injection of cortisone in the heel.
In extreme cases where pain is significant and you need to remain
mobile, we utilize removable casts that can come off to bathe, drive,
and sleep. Surgery is rarely necessary. |
For cases that do not respond to conventional conservative care, we
have now turned to extra corporeal shockwave therapy (ESWT) with great
success (see Treatment Breakthroughs section). This is a non-invasive
way to treat heel pain without surgery, disability, crutches, casting,
etc. |
How long will the effects last? |
You may find that the pain is sometimes worse and sometimes better
over time. If you get treatment soon after you notice the pain, the
symptoms may go away easier and quicker than if you wait to get treatment.
If, however, you have had plantar fasciitis for a long time, it may
take may take quite some time for the pain to go away. |
When can I return to my sport or activity? |
The goal of rehabilitation is to return you to your sport or activity
as soon as is safely possible. If you return too soon you may worsen
your injury, which could lead to permanent damage. Everyone recovers
from injury at a different rate. Return to your sport will be determined
by how soon your foot recovers, not by how many days or weeks it has
been since your injury occurred. In general, the longer you have symptoms
before you start treatment, the longer it takes to get better. We
take great pride in finding ways for you to continue exercising without
prolonging your injury. Cross-training in non-impact sports is usually
an accepted alternative to the impact sports. |
How do I prevent plantar fasciitis? |
The best way to prevent plantar fasciitis is to wear shoes that are
well made and fit your feet. This is especially important when you
exercise, walk a lot, or stand for a long time on hard surfaces. Get
new athletic shoes before your old shoes stop supporting and cushioning
your feet.
You should also:
• Avoid repeated jarring to the heel.
• Maintain a healthy weight
• Stretch when you
feel a tightening of the ligament that runs along the bottom of your
foot
• Stop impact sports when symptoms first occur.
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