FREE Physical Therapy - Vol. 2-Heel Pain, August 2006
Heel Pain (Plantar Fascitis)
Do you suffer from heel and/or arch pain that is at it's worst the first thing in the morning and when you get up from sitting after a period of time? Does it feel like you are being stuck in the foot with a hot poker? You could be suffering from plantar fascitis. Plantar fascitis (heel spur syndrome) is the inflammation of the thick, fibrous band of connective tissue located under your foot that originates at the calcaneous (heel bone) and radiates up toward the base of the toes. The body’s reaction to this inflammation may cause the formation of spike-like projections of new bone, commonly referred to as heel spurs. Heel spurs, despite common misconceptions, do not cause the initial pain, nor are they the initial problem. Heel spurs are the result of a problem. What causes this inflammation and, more importantly, what can you do to treat it? This article will discuss the most common causes, contributing factors and treatments of plantar fascitis.
Plantar fascitis can occur in people of either sex, usually over the age of 40, except in the case of people with very active lifestyles. It is commonly found in people whose occupation involves prolonged standing or walking. Sudden increases in activity level or weight gain can also contribute to the development of plantar fascitis. Bone structure of the foot also plays a big part in plantar fascitis. People with flat feet have excessive pronation. This excessive pronation causes a prolonged duration of pronation with walking which can lead to chronic irritation and possibly even microtears at the plantar fascia origin. On the opposite end of the spectrum, a cavus, high arched (supinated) foot usually has a tight plantar fascia, which subsequently doesn't have the ability to disperse the force that is placed on it. This supination results in an increased load on the plantar fascia, which can cause irritation and pain. A final contributing factor to the development of plantar fascitis is poor shoe support. The type of support and best shoe for you depends on your foot structure and activity level. Most specialty shoe stores are able to help you find the right type of shoe.
Treatment for plantar fascitis is directed at both a short-term goal to control inflammation and to relive stress on the fascia as well as on a long-term goal of correcting the mechanical contributing factors. Initial home treatments include rest, anti-inflammatory medications and ice.
Soft tissue stretching of the gastro (calf) muscles as well as the plantar fascia is also beneficial. Gastroc stretching can be performed in a lunge position by placing your sore foot behind and your non-affected foot in front. Place your hands on a wall/table and while keeping your back knee straight, gently lean toward the wall/table until a pull is felt in the calf of your back leg. Hold this stretch for 15-30 seconds and repeat 3-5 times at least 3 times a day.
Doctor frequently recommend physical therapy for this type of problem. Physical therapy can include a combination of whirlpool to decrease tightness, ultrasound with hydrocortisone cream to decrease inflammation, various massage techniques to break up scar tissue, stretching, strengthening and/or balancing exercises. Surgery to release the plantar fascia might also be recommended by your physician if the pain is still intense after several months of trying conservative treatments.
Plantar fascitis is a common problem that often requires persistent treatment on your own, possibly with assistance of physical therapy. Plantar fascitis can take up to a year to heal completely-so don't give up on your treatment and exercises. Be patient and hang in there!
*All information is intended for your general knowledge and education only and is not a substitute for direct medical advice or treatment for specific medical conditions.
