Heel Pain and Plantar Fasciitis6/21/2011
The most common patient compliant I see in my office is 'heel pain' (over 1,000 patients per year). I think it may be valuable to give a short explanation of the most common source of heel pain: 'plantar fasciitis':
We believe most heel pain is due to overstretching or actual micro-tearing of the 'plantar fascia'. The plantar fascia is a tight band of support tissue in the arch connecting the heel bone to the ball of the foot. It is tighter in people with higher arches. Simply, when you step down on your foot, your arch collapses a bit and the plantar fascia gets pulled tight, when you're off your foot, its loose.
When someone has plantar fascitis, they complain of pain in the morning and pain after rest, often so bad that it is hard to walk. After a few minutes each morning the extreme pain may go away, but the dull aching pain remains most of the day. We believe the pain is caused by small tears in the plantar fascia, which can happen from doing a variety of things, like: hiking with a backpack, uphill treadmill, overtraining, step aerobics class, walking up and down ladders, falling hard from a height, gaining 5-10 pounds, etc. Sometimes we don't have a good explanation for how the tears happened, but the pain is there.
Once you have a small tear in the plantar fascia (and it almost always tears right near the heel bone), you have pain everytime you change the tension of the plantar fascia. As I said above, when you are in bed at night, since you're not standing on your foot, the plantar fascia is not tight; on the other hand, when you are standing the plantar fascia is pulled to its maximum tightness---if there is a tear in the fascia it will hurt when you transition from sitting to standing.
Heel Pain Treatment
The treatment involves trying to hold the plantar fascia tissue at the same tension most of the day and all night, for about a month, so it can heal. We have patients do 4 daytime activities:
- Wear arch supports to hold up your arch, thereby keeping the plantar fascia from being pulled to tight and the tears from being pulled apart while walking
- Wear shoes ALL THE TIME, even around the house (this is a tough one)
- Ice your heel daily
- Stretch your achilles tendon 10 times/day
At night, we advise patients to wear a night splint, which holds your foot in a stretched position all night, holding the fascia at about the same tension as it is held in all day by the arch supports. By doing these 4 daytime activities and the night splint, the fascia is held at a constant tension and the tears will finally heal, and pain goes away.
We have all of these items (arch supports and night splints) available in our office. Sometimes we also give injections to help. Most people (over 90%) get better without having to pursue more aggressive treatments, like surgery.