Don't Suffer With Heel Pain - It Can Easily Be Treated

The diagnosis and treatment of heel pain amounts to over a million visits to medical professionals annually in the USA.  And although a quarter of all injuries in runners involve heel pain, this ailment is not confined to sports people but affects people with all levels of activity – including the sedentary.  The most common heel condition is called plantar fasciitis – inflammation of the plantar fascia. Over three million Americans are currently living with this condition, which is most common in people aged 45 to 64.

What are the plantar fascia?

Fascia are a fibrous thin layer or sheet of tissue which appears throughout the body. It is mainly made up of collagen, a protein, and is not very stretchy i.e. it does not contain many elastic fibres. Due to its "woven" structure, fascia can stretch more in one direction than in another. Like ligaments it forms an inelastic material linking bones and other structures.  

The plantar fascia is found in the sole (plantar area) of the foot, and it runs from the heel into the base of the toes, so it is a major component of the foot. Importantly, the plantar fascia spans the arch of the foot and plays a role in helping to maintain the arch.

What is plantar fasciitis?

Plantar fasciitis occurs when small tears appear in this tissue, causing an inflammatory reaction, as the body gets ready to repair the damage. This inflammation means that there is increased blood flow to the area, bringing blood and other fluids and specialized cells in for the repair effort. The increased fluid and chemicals to the area irritate nerve endings, causing pain. This mechanism is a nuisance, but it also serves to make people rest their foot, allowing healing to take place.

What does plantar fasciitis feel like?

Sometimes, pain caused by plantar fasciitis is felt in the arch or centre of the sole, rather than in the heel. But on examination a foot specialist (podiatrist) will apply pressure over a bony protrusion of the heel (the medial tubercle) which is just at the start of the arch on the inner border of the foot.  In many cases of plantar fasciitis this will cause pain or discomfort for the sufferer.

The pain of plantar fasciitis is frequently felt most with the first steps after getting up from bed or from sitting, and also at the end of the day.  The reason for this is that in both situations inflammatory fluid will have collected in the foot – when you’re standing and walking this gets ‘pumped’ away.  There is not much room in the foot for additional fluid, so those first few steps force the fluid between the tissues which is — not surprisingly – rather uncomfortable. 

Also, when you first stand up you stretch the plantar fascia as you bear your bodyweight on your feet, and this pulls on the tears in the already injured tissue, causing pain.

What Are The Causes Of Plantar Fasciitis?

In my experience as a podiatrist, the underlying causes of plantar fasciitis are as numerous as the people who develop the condition.  Common ones I’ve come across include people changing their level of activity e.g. taking a job as a mail man after previously working behind a desk. One man I treated was overweight and had been very sedentary. He decided to take up speed-walking, but soon developed painful feet.

Another lady had been very active, playing netball several nights a week.  But she had to have an unrelated abdominal operation (hysterectomy) so was unable to play sports for several weeks. After her recovery time was over she went back to playing netball exactly as before, and rapidly developed plantar fasciitis. 

Yet another patient had changed his kitchen flooring from carpet to ceramic tiles – which are much harder and unyielding – and as a result developed plantar fasciitis. 

I would say that changes in occupation, increase in activity levels and weight gain are probably the most common general causes of plantar fasciitis.

Can plantar fasciitis be treated?

The good news is that plantar fasciitis very commonly gets better on its own – this condition is what is called self-limiting. The bad news is that once you’ve had an episode, you are very likely to suffer with plantar fasciitis again. One reason for this increased vulnerability is that you may have residual damage that doesn’t quite heal, and so plantar fasciitis flares up from time to time. The other reason is if the cause – whether that is to do with foot function, footwear or excessive weight - has not been addressed.

Self-help

Firstly, combat inflammation with RICE – rest, ice (such as a bag of frozen peas applied to the foot), compression and elevation (sitting with your foot up to drain away with fluid). Non-prescription painkillers such as non-steroidal anti-inflammatory drugs like Aspirin or ibuprofen help some people, but not all.

Regularly rolling a chilled drink can under the arch also reduces discomfort and inflammation.  Circling your feet in the air to stimulate circulation before you stand up after sleep or rest, can help reduce the pain of those first few steps.

Professional help for plantar fasciitis

These self-help measures deal only with symptom relief while the body heals itself – they do not address the cause of plantar fasciitis. As mentioned, if the cause remains untreated, you are at high risk of suffering another episode.

They can perform tests to rule out other conditions such as fractures and nerve entrapment syndromes, or refer you to someone who can.  

If they confirm a diagnosis of plantar fasciitis they can analyze your gait (walking pattern) and provide you with orthoses (insoles to wear in your shoes) and exercises to prevent further attacks of plantar fasciitis. They may also be able to offer symptomatic relief with ultrasound, injections of steroids or local anesthetic, or extra corporeal shock wave therapy.  As a last resort they may refer you for surgery to treat your plantar fasciitis.