What is the Cause of My Heel Pain?
Heel pain is a frequent ailments that podiatrists treat. One of the most common causes of heel pain is due to plantar fasciitis. The plantar fascia is a large ligament that extends from the heel to the toes and is a big supporter of the arch. When this ligament becomes inflamed and irritated, we refer to this as plantar fasciitis.
One of the main symptoms of plantar fasciitis is pain that is worse when someone first gets up out of bed in the morning or gets up after a period of rest. This pain will initially start to improve after a few steps of walking, but then will reoccur again after getting up from another period of rest. Symptoms can also occur after long periods of standing and also can worsen following exercise.
Plantar fasciitis can occur in a variety of age groups. Some of the factors that can make patients more prone to developing plantar fasciitis are:
- Those with a flat foot type
- Those with tight calf muscles
- Those who have a high arch foot type
- Certain athletes such as distance runners
- People who have occupations that require them to be on their feet all day long
- Certain shoegear and spending a lot of time barefoot can also trigger plantar fasciitis. Flip-flops are one of the most common culprits of plantar fasciitis in the summertime and shoes that are highly flexible with little support can also trigger it.
There are a variety of treatment options for plantar fasciitis and your doctor will be able to provide you with treatment options that could best suite you. The majority of plantar fasciitis cases can be resolved with conservative care without surgical intervention. Here are some of the treatment options that your doctor may suggest:
Shoe gear: Your doctor will likely examine and discuss the shoes that you wear on a daily basis. It is important to wear shoe gear that has a good arch support and to avoid spending a lot of time barefoot. Your doctor will be able to suggest certain brands and styles to help you find supportive shoe gear for work, exercise and leisure. Sometimes even just changing the shoe gear can lead to significant improvement in plantar fasciitis symptoms.
Arch Supports/Custom Orthotics: There are a variety of different arch supports that are marketed today. Some are better than others and your doctor will be able to provide you with a list of which ones to try. Your doctor may also discuss with you the option of custom orthotics, where an insert is made specifically for your foot and is superior to over-the-counter inserts. Some insurance plans will cover custom orthotics, while others do not. Ask your doctor if custom orthotics would be a covered benefit under your plan.
Anti-inflammatories and Ice: Anti-inflammatories and ice can both help to reduce inflammation, which can help relieve pain. Sometimes your doctor can write you a prescription strength anti-inflammatory to help further reduce inflammation. It is recommended to ice your foot after any activity, and at the end of the day when dealing with plantar fasciitis. Some patients prefer freezing a water bottle and rolling it along the bottom of the foot.
Calf Stretches or Physical Therapy: Having tight calf muscles can be a trigger for plantar fasciitis. If you do have tight calf muscles it is important to do daily calf stretches. Your doctor will be able to provide you with a list of stretches. Sometimes if calf stretches are not enough, your doctor may suggest wearing a splint at night that can stretch the calf while you are sleeping. Physical therapy is another option that your doctor may suggest to further help you with your flexibility.
Injections: For patients that have significant pain and inflammation, your doctor may suggest a cortisone injection. The injection is given typically right where the plantar fascia attaches to your heel bone and helps to reduce inflammation in the area. Typically the injection given is a long acting steroid and can take a few days to start working. Even if the injection gets rid of all the pain, it is still important to make sure you continue to wear proper shoe gear, stretch and use the inserts your doctor suggested– otherwise the plantar fasciitis can reoccur in the future.
Extracorporeal Shockwave Therapy (EPAT): EPAT is a treatment option for those that suffer from chronic plantar fasciitis. EPAT is a non-invasive procedure which works by using pressure waves to increase blood flow and metabolism to the injured area in order to help accelerate the healing process. Most patients will undergo 3 different treatment sessions, over 3 consecutive weeks, with each treatment lasting about 10 minutes. During this treatment period your doctor will have you stop taking any anti-inflammatories and icing because this can interfere with the EPAT’s effectiveness. The best results from the treatment are usually seen about 6 weeks following the last treatment.
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