Plantar fasciitis is one of the most common causes of heel pain. It is an irritation or inflammation of the plantar fascia – the structure that runs from the heel to the ball of the foot. This is a strong, dense strip of tissue that supports the arch of the foot, almost like the string on an archer’s bow. When the foot is on the ground, the full weight of the body is concentrated on the plantar fascia, forcing it to stretch as the arch of the foot flattens from the full weight of the body. In the example of the archer’s bow, if the bow is trying to straighten, picture the string being forced to stretch.
This leads to stress on the plantar fascia where it attaches to the heel bone. This may lead to small tears of the fascia. These tears are usually repaired by the body, but repetitive stress may result in incomplete healing. A bone spur can result as the body tries to compensate for too much stress.
If Your First Steps are Painful
Pain in the heel can occur due to bone spurs, inflammation of the plantar fascia (known as plantar fasciitis), or impingement of the small nerves in the foot.
Physical Symptoms of plantar fasciitis include pain on or around the heel when weight is placed on the foot. This is usually worst in the morning, especially with the first few steps after getting out of bed. In most cases, there is no pain at night since the fascia tightens up overnight. Morning motion causes pulling of the fascia and results in pain that can be described as sharp, burning, or stabbing. The pain usually reduces during the course of the day as the tissue warms up. Prolonged standing, walking, or getting up after long periods of sitting usually irritates the fascia.
Common causes of heel pain include:
- Excessive running or jumping
- Overload of physical activity (especially for athletes)
- High arches, flat feet, abnormal gait
- Wearing improper shoes while walking or running
- Diabetes contributes to heel pain in the elderly
- Recent weight gain or pregnancy
Taking the Right Steps to Relieve Heel Pain
In most cases, plantar fasciitis does not require surgery and can be treated conservatively. However, every individual heals at a different pace.
If you suffer from heel pain, the first thing you need to do is determine the cause. For example, you may need to replace your old, worn-out shoes. You may need to rest if there has been a significant increase in your activity levels.
The next thing to do is to call your physical therapist. You may even need to see a doctor or podiatrist. Your doctor may prescribe anti-inflammatory medications and physical therapy to help you reduce pain and inflammation and resume daily activities without pain. In some cases, your doctor may give you a cortisone shot to address excessive inflammation.
Most people with heel pain get better with physical therapy. Therapy usually includes stretching the calf muscles (on the back of the lower leg) to take the tension off the plantar fascia. If your calf is really tight, the doctor may order a night splint (to be worn while you sleep at night). This will place a mild stretch on the calf muscles and the plantar fascia. This helps reduce morning pain.
Patients with plantar fasciitis are commonly prescribed physical therapy. Our therapists design exercises to improve flexibility in the calf muscles and the plantar fascia. Treatment helps control pain and swelling. We may use ultrasound, electrical stimulation, ice packs, and soft-tissue massage to help you recover as fast as possible. We may even recommend the use of an orthotic depending on the anatomy of your foot.
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