Common Foot and Ankle Problems & Treatments
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Plantar Fasciitis (Heel Pain)
Plantar fasciitis is an inflammation of the tissue on the bottom of your foot. Pain usually occurs on the inside of the arch or heel. A podiatrist can differentiate from other problems such as osteoarthritis, gout, growing pains, fractures, nerve pain, fascial tears or tendonitis. It may or may not be accompanied by the formation of a heel spur; regardless, the symptoms and treatments remain the same.
What are the symptoms?
The main symptom of plantar fasciitis is heel pain after rest when you start to walk. There is usually no pain while the fascia is relaxed during sleep but pain typically occurs first thing in the morning after you get out of bed, when your foot is placed flat on the floor. The pain occurs because you are stretching the tightened, inflamed plantar fascia and the pain usually lessens temporarily with more walking as you stretch out.
How is it diagnosed?
The diagnosis is usually made by collecting the symptoms and locating the exact area of pain. An x-ray of your heel may be done to rule out other causes of heel pain, such as arthritis, cyst formation in the heel, fractures, etc.
What causes arch or heel pain?
There are several possible causes of plantar fasciitis, including:
- Wearing high heels, loafers or flats without support.
- Gaining weight.
- Increased walking, standing, or stair-climbing.
- Starting a new exercise without proper training techniques.
- Tight heel cords.
- Flexible or pronated feet
If you wear high-heeled shoes for long periods of time, the tough, tendon-like tissue of the bottom of your foot can become shorter. If you engage in activity without adequate arch support the plantar fascia will get inflamed. This will become painful.
Runners may get plantar fasciitis when they change their workout and increase their mileage or frequency of workouts without appropriate build-up of base mileage in training. Shoes that are not supportive or are not replaced often enough can also cause an irritation.
If the arches of your foot are abnormally high or low, you are more likely to develop plantar fasciitis than if your arches are normal.
How is arch or heel pain treated?
Once the accurate diagnosis is made, your podiatrist can discuss treatment strategies. These may include: modifying your activity, icing the area, stretching/ physical therapy, anti-inflammatory medicines, injections, strapping, over-the-counter arch supports or custom orthotics.
Give your painful heel lots of rest. You may need to stay completely off your foot for several days when the pain is severe.
We may recommend or prescribe anti-inflammatory medications, such as aspirin or ibuprofen. These drugs decrease pain and inflammation. Resting your heel on an ice pack for a few minutes several times a day can also help.
Try to cushion your foot. You can do this by wearing athletic shoes, even at work, for a while. Heel cushions can also be used, but support is usually more beneficial. The cushions or supports should be worn in both shoes.
An orthotic arch support, specially molded to fit your foot, may be part of your treatment. These supports can be particularly helpful if you have flat feet or high arches. You can tell if that is what is needed when short-term taping decreases your heel pain.
If your heel pain is not relieved by the treatments described, your health care provider may recommend physical therapy. The goals of physical therapy are to stretch the plantar fascia and to strengthen the lower leg muscles, which stabilize the ankle and heel.
Sometimes we dispense a splint, fitted to the calf of your leg and foot, to be worn at night, to keep your foot stretched during sleep. Another possible treatment is injection of cortisone in the heel. In extreme cases where pain is significant and you need to remain mobile, we utilize removable casts that come off to bathe, drive and sleep. Surgery is rarely necessary.
For cases that do not respond to conventional conservative care, we use extra-corporeal shockwave therapy (ESWT) with great success. This is a non-invasive way to treat heel pain without surgery, disability, crutches, casting, etc.
How long will the effects last?
You may find that the pain is sometimes worse and sometimes better over time. If you get treatment soon after you notice the pain, the symptoms may go away more easily and quickly than if you wait to get treatment. If, however, you have had plantar fasciitis for a long time, it may take may take quite some time for the pain to be relieved.
When can I resume my sport or activity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon, you may worsen your injury, which could lead to permanent damage.
Everyone recovers from injury at a different rate. Returning to your sport will be determined by how soon your foot recovers, not by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer it takes to get better.
We find ways for you to continue exercising without prolonging your injury. Cross-training in non-impact sports is usually an accepted alternative to impact sports.
How do I prevent plantar fasciitis?
The best way to prevent plantar fasciitis is to wear shoes that are well made and fit your feet. This is especially important when you exercise, walk a lot, or stand for a long time on hard surfaces. Get new athletic shoes before your old shoes stop supporting and cushioning your feet.
You should also:
- Avoid repeated jarring to the heel.
- Maintain a healthy weight.
- Stretch when you feel a tightening of the ligament that runs along the bottom of your foot.
- Stop impact sports when symptoms first occur.