Heel Pain: Plantar fascitis
Do you suffer from pain in your heel? Especially, a stabbing pain that usually occurs with the first few steps from your bed in the morning, or with prolonged standing in hard shoes on a hard floor? Or any sharp pain in the heel with only the first steps of a run and worsened pain after the run is completed? Or maybe you have pain after getting up from a seated position for some time.
In such cases, press on the medial (inner) aspect of your heel. If you have a strong painful or burning sensation, it could be plantar fasciitis.
This condition is the most common cause of heel pain, and is an inflammation of the connective tissue called the plantar fascia that runs across the bottom of the foot, connecting the heel to your toes.
Plantar fasciitis most commonly occurs in women, between the ages of 40 and 60, or people who are overweight. Exercise that places a lot of pressure on the heel, such as long distance running, ballet dancing or aerobics, can contribute to this condition. Occupations such as teachers or waitresses can be another risk factor.
The outcome is generally good, with approximately 80 to 90 percent of people who have plantar fasciitis recovering within a year after conservative treatment. Effective conservative treatment that you can do at home includes the following:
Rest – Resting and limiting athletic activities can reduce the newly aggravated pain. But do not take a complete rest because stiffening can alter your pain. Swimming or bicycling instead of walking or jogging is recommended.
Applying ice – Applying ice for 15 to 20 minutes up to four times daily or after activity can reduce pain and inflammation.
Put your feet up – Especially while you are sleeping if the pain is severe.
Protective footwear – Athletic shoes or arch supporting shoes can take the tension off the plantar fascia and help absorb shock.
Stretching exercises as listed below can be also helpful.
1) Heel stretching with a towel: Wrap a towel around the toes and pull the foot towards you. Hold for 10 to 30 seconds. Repeat five times each session and do two sessions a day.
2) Calf stretches against a wall: Lean forward into a wall onto outstretched hands,
3) Towel curls: Curl your toes around a towel. Then grip and release the towel over and over again for one to two minutes, twice a day
Most of all, you have to confirm your problem with a physician to differentiate it from other conditions, such as a stress fracture or fat pad syndrome. And if you don’t get better with these conservative treatments, your doctor may recommend some pain medication or night splints.
Wearing night splints fitted to your calf and foot can hold the plantar fascia and Achilles tendon in a lengthened position overnight to be stretched. This may be more effective if your symptoms have lasted more than 12 months.
The last treatment step could be referral to the Orthopedic Department for extracorporeal shock wave therapy or surgery, but only a small percentage of people need surgery to detach the plantar fascia from the heel.
The author is a clinical instructor at the Seoul National University Hospital International Healthcare Center (SNUH-IHC).