Treating Heel Pain: Plantar Fasciitis

November 14, 2011 Posted by Dr.Chang

By far, the most common cause of heel pain, plantar fasciitis, is inflammation of the plantar fascia, the tendon that runs along the bottom of your foot and around your heel.  The plantar fascia tissue contributes to supporting the arch in the foot and distributing body weight across the foot. The plantar fascia bears up to 14% of the pressure exerted on the foot. When the plantar fascia becomes inflamed, doctors term the condition plantar fasciitis. Plantar fasciitis is often associated with abnormalities of the foot’s structure, such as high arches (pes cavus) and flat feet. Environmental factors can also cause plantar fasciitis – whether running on pavement or in worn out shoes, running long distances or increasing our training too quickly, or even by experiencing sudden weight gain, we can put undue strain on our plantar fascia.

For an effective plantar fasciiits treatment strategy, first consult Dr. Murray and Dr. Changto target the causes of your injury. Many treatment strategies exist for plantar fasciitis, but the treatment plan that you adopt should be specific to your individual injury. Do you have flat feet, and therefore would benefit from wearing orthotics, supportive shoes and doing foot-strengthening exercises? Do you have a heel spur that is causing your plantar fasciitis? Have you increased your training too rapidly, in which case you should take some rest days until the inflammation and pain recede and then reconsider how you ramp up your training plan? And what about the surfaces that you are regularly running on? Your everyday footwear? Lifestyle changes such as sudden weight gain? Do you have other possible conditions, deformities of the foot, or injuries to which your plantar fascia may be responding? In short, there is no one-way to treat plantar fasciitis. Without considering the cause of your own injury, it is unlikely that you will heal from it without reoccurrence.

After diagnosing you with Plantar Fasciitis, your podiatrist will recommend that you temporarily slow down. Being sure not to stand for long periods of time will help your feet heal, and a reduction in activity could include easing up on a range of activities from running to walking in bare feet. Note that resting your plantar fascia does not mean stopping activity and exercise altogether – you may have to identify exercises that don’t aggravate your heel pain, but in general, mild exercise will help strengthen and stretch the muscles in your foot, and increased blood flow to the affected area will help your foot heal. You may want to try swimming, or an easy session on the elliptical. Ask your podiatrist for suggestions on mild stretching and strengthening exercises for the plantar fascia and beyond.

Your podiatrist will also recommend a variety of active treatments. First, you should seek out shoes with arch support for exercise and everyday use. Arch support could come from padding such as heel cups, footpads, shoe inserts and custom made orthotics. Night splints are incredibly effective – these keep the foot flexed and the plantar fascia in its resting position overnight, making it much easier to take the first few steps in the morning. While it may be difficult to get used to sleeping in these night splints, you will feel positive results soon after you begin wearing a night splint, making the initial discomfort well worth the effort!

Heat and ice are great aids to plantar fascia treatment. Applying a warm heating pad to your heel before exercise can relax the muscles, making them looser for exercise. After exercise, icing is recommended to reduce the inflammation and to provide pain relief. Massaging your foot by rolling it on a frozen juice can is a great trick, and will get massage and icing out of the way. Whether you use this trick or kick back to ice your feet, you should adopt a 20 minute/twice a day icing routine to reduce your plantar fascia inflammation. Your doctor may also recommend that you take non-steroidal anti-inflammatory drugs, or NSAIDs, such as Ibuprofen, Advil, Motrin or Aleve. These work by blocking enzymes that stimulate swelling to reduce the pain caused by inflammation. Once you are on the mend, your podiatrist may instruct you with how to support the arch of your foot with athletic tape, a support that may help you ease back into exercising.

In the most severe cases, boot castes may be prescribed, and even steroid shots or injections may be given. If pain continues, in very extreme cases, your podiatric surgeon may suggest surgical methods.

Note that the reoccurrence rate of plantar fasciitis is fairly high. It is easy to feel as though your plantar fascia has recovered, and frustrating when the pain resurfaces the next morning, the next month, or the next year. Note that the reoccurring pain may surprise you when you put weight on the injured foot after resting. In this case, finding a consistent preventative routine may be key for you. In general make sure your ankle, your Achilles tendon and your calf muscles are flexible and strong with stretches and strengthening exercises prescribed by your podiatrist or physical therapist. Be sure that you are not exercising with old, worn-out footwear, and that your day-shoes are supportive and well fitted (in support, size, width and cushioning), to your individual feet.

Most of all, exercise diligence with your plantar fascia care and patience with healing your plantar fasciitis – it will take some time, in some cases up to a year, but these guidelines provide success for most plantar fasciitis sufferers.

 

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