Patient Education

Heel Pain (Plantar Fasciitis)

Description

The bottoms of things have, in general, been much maligned. The bottom of the barrel, bottom of the ocean, bottom of the slag-heap, and more bottoms are generally thought of as dark, dirty, or otherwise unpleasant places. But just think how important bottoms can be: the bottom of a ship, for instance, while sometimes sloshing with bilge-water, is nonetheless essential in a ship’s overall well-being. When its bottom fails, the ship goes down to the bottom of the ocean. Which is full of bottom-dwellers, as we well know.

The bottoms of feet are likewise very important. Think about it: all the weight of your body presses down on your poor, overworked feet. And towards the bottom of the foot is a band of tissue called the plantar fascia (a fascia is similar to a ligament) which connects to the bottom of your heel bone and fans out to the base of your toes. It helps support the structure of the bones at the bottom of your foot. Unfortunately, we don’t seem to appreciate what the plantar fascia does for us until it decides to go bottoms-up.

Like many tissues, the plantar fascia can become stretched over time, particularly in people with unusually high or low arches, or who are overweight, tend to do a lot of physical activity like running and jumping, wear shoes with little or no support, or have a tight Achilles tendon. Spending a lot of time on hard, flat surfaces (like a concrete floor) can also lead to problems. Plantar fasciitis may show up in either gender, although it most often affects people in late middle age (about 40 to 60).

When the plantar fascia stretches too far, it can develop small tears (or in extreme cases may even rupture). These tears make the plantar fascia irritated and inflamed, a condition known as plantar fasciitis.

Symptoms

Plantar fasciitis tends to manifest itself as pain at the bottom of the heel (although it can occur at any point along the arch of the foot) which is usually most severe when getting up in the morning (or in the afternoon if you like to sleep in a lot). The pain often subsides during the day as you walk around a little, although it may become worse again if you’re on your feet a great deal, or if you sit for awhile and then try to stand again. Many patients feel a searing or sharp pain when they first get on their feet after a period of rest. This may subside to a dull ache as the day goes on.

This condition tends to get worse over time, so you may start off with very little pain that gradually progresses to severe over a period of months. Your arches may also gradually flatten as the plantar fascia stretches out.

Additionally, you may develop a heel spur (a bone growth along the bottom of your heel bone). In the past, it was thought that the spur contributed to the pain, but, since many people with heel spurs experience no symptoms, this is no longer thought to be the case.

Diagnosis

When you go in to see your podiatrist about the pain in the bottom of your heel, be sure to come prepared to answer questions (and ask questions of your own, of course). Your doctor will probably want to know a history of your symptoms and will perform a physical exam of your foot to check for swelling and redness. He or she may also check for tenderness on the foot to find out where the pain is coming from. You may need to get X-rays to check for other possible sources of your pain (such as stress fractures).

Treatment

Getting your plantar fascia to feel better usually revolves around some conservative treatments. These may include anti-inflammatory medication (such as ibuprofen), ice (20 minutes on the foot over a thin towel, then 40 minutes off), doing exercises to stretch the calf muscle, wearing shoes that give better support to the foot (such as those with a slightly elevated heel and decent arch support), avoiding going barefoot, and giving your feet a rest by avoiding activities that stress them out (like certain sports or standing for long periods).

Persistent pain may need slightly more extensive treatment, such as the use of orthotics (custom-made shoe inserts), a walking cast to keep your foot immobile or a night splint to stretch the plantar fascia out. Your podiatrist may also suggest physical therapy (including extracorporeal shock wave therapy), padding and strapping (or taping) the foot to ensure things stay in their proper positions, and cortisone injections (although you don’t really want to have more than one of these, since repeated injections can weaken the fascia).

Although it’s rare, very persistent plantar fasciitis may need to be addressed with surgery if it fails to respond adequately to the above treatments. Surgery usually involves releasing the fascia from the bottom of the heel bone, although this may weaken the arch of the foot, and may have other complications, including as infection and nerve injury. Be sure to discuss all possible treatments with your foot doctor.

After receiving treatment, your plantar fascia should stop causing you so much pain. But really, the whole experience should make you appreciate the bottom of your foot that much more. And then you can thank it. From the bottom of your heart.