Plantar Fasciitis

Pain in the bottom of the heel is among the most common foot problem. People with this symptom usually say there was no trauma to the heel, and that they experience sharp pain when taking the first few steps in the morning. The pain usually improves in the next few minutes and may or may not get worse as the day goes on. In the evening after resting, that same sharp pain returns when the person gets up and walks.

It's important to understand the biomechanics of the foot. Picture a band that runs from the bottom of the heel to the ball of the foot. This band is called the plantar fascia. When a person puts weight on the foot, if it has any flexibility the force of the weight will cause the forefoot to splay away from the rearfoot.

This causes a stretching or tearing of the plantar fascia. The plantar fascia does not stretch easily, so when it goes beyond its ability to stretch, it tears at its weakest point, usually at its insertion point on the bottom of the heel bone.

The distance between the heel and forefoot is the shortest when a person is sleeping — the forefoot is then hanging downward — or when driving, sitting, or in any non-weight-bearing position. That is why morning pain is a common complaint: the foot tightens up overnight and tears the band away from the heel with that first step.

If a spur is present, the patient is considered to have heel spur syndrome. If no spur is present, then the diagnosis is simply inflammation of the plantar fascia. Only an X-ray will determine whether there is a spur, but treatment is the same in either case. A spur does not have to be removed to relieve the heel pain. Many people think that the spur is jabbing into surrounding tissue and producing pain. It is the tearing effect of the band that causes the pain. If that splaying effect can be eliminated, then the band will no longer tear.

The treatment is usually an over-the-counter arch support, called an orthotic, or, if needed, a custom molded orthotic. Over-the-counter orthotics are made for a standard arch, so a person with a flexible high-arched foot most likely will not get the needed support, and a person with a flat foot will not be able to tolerate a device that creates too much pressure on the arch. The key is finding the right device and wearing it all the time — at work and at home — which will allow the fascia to heal. (Do not walk barefoot)

A podiatrist usually takes an X-ray during the initial visit and recommends a device for the patient's arch. Antiinflammatory drugs, such aspirin, taken with meals may help. The podiatrist may prescribe ice massages, stretching exercises and/or a night splint. If that does not help, the person may need a cortisone shot or physical therapy. In some cases, surgery is performed to cut or release a portion of the band from its insertion on the heel bone. It then heals in a lengthened position so it no longer tears. Do not jump into surgery, however, since it is seldom necessary and there are no guarantees that it will be successful.

There are other conditions that mimic heel pain, such as rheumatoid arthritis, gout, nerve entrapment or referred pain from back conditions. These should also be ruled out by a doctor.

An important part of self treatment for this condition is being sure that your shoes offer motion control and are optimal controlling the forces that contribute to plantar fasciitis and heel spurs. Check your running shoes to make sure that they are not excessively worn. They should bend only at the ball of the foot, where your toes attach to the foot. This is vital! Avoid any shoe that bends in the center of the arch or behind the ball of the foot. It offers insufficient support and will stress your plantar fascia. The human foot was not designed to bend here and neither should a shoe be designed to do this.

Some of the most useful home treatments are as follows:

• Ice - this is the most important thing you can do for yourself. Either an ice pack under the sole of the foot of take a frozen can of juice and roll in under your foot to do a bit of ice massage.

• Home exercises to strengthen the plantar muscles - practice picking a golf ball up with your toes, or lay a towel on the floor and scrunch it up with your toes.

• When severe, bracing at night may be necessary - because things tighten up when we point our toes at night sometimes a splint which holds the foot in dorsiflexion (toes up) may be necessary. Commercial ones are available but one of the best ways to splint your foot is to sleep with a boot on your foot. A ski boot works great because it won't flex at all but any high, stiff boot should suffice. It may seem clumsy but I've had people who've found this was the trick in fixing their foot.

• Soak with Epson salts - hot water and Epsom salts will draw inflammation out of the sore muscles.

And… According to Dr. Andrew Weil - "Reflexology is a foot-focused therapy that I think is more than just a relaxing spa treat. It's a health- supporting treatment. I've prescribed reflexology for plantar fasciitis and other foot and ankle problems, with good results." -Nancy Bartlett