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Fifteen Ways to Fight Heel Pain

There are many different causes of heel pain, but the mostcommon cause is plantar fasciitis (plan * tar fash* ee * I *tis). If you experience a sharp pain in your heel when youfirst step down in the morning, it is most likely due to plantarfasciitis. This problem is a result of excess stress through along ligament type structure (the plantar fascia) in thebottom of the foot. The excess stress causes tearing andresults in inflammation and pain. The classic symptoms arepain in the heel at the first step in the morning, or uponrising after long periods of rest. Many will complain of asharp pain in the heel when they step out of their car or afterfinishing their lunch break. Other individuals only experienceheel pain at the end of the day or during certain types ofactivity like running, soccer or tennis. The pain may extendinto the arch and feel achy at the end of the day.

Individuals develop plantar fasciitis for a variety of reasons.One of the most common reasons for the development ofplantar fasciitis is wearing poor quality or worn out shoes.Another common reason is starting a new activity, such aswalking or running, after a period of inactivity. Many activeindividuals develop plantar fasciitis after incorporating hills,stairs or uneven terrain into their training routine. A new jobthat requires standing all day or switching to a job with aharder surface, like cement floors, may contribute to it'sdevelopment. Individuals with flatfeet or excess pronation(rolling in of the feet) may have a natural predisposition forplantar fasciitis. Regardless of how the problem started, thetreatment is aimed at decreasing the stress on the arch anddecreasing the inflammation.

1. Identify the cause: There is usually a reason for thedevelopment of plantar fasciitis, but since the condition isnot typically associated with an acute injury it may be hard toremember. The pain may have gradually developed afterstarting a new training routine, changing the routine, runningor walking on a new surface, switching shoes, wearingworn out shoes or starting a new job. Once the cause isidentified, stop the activity or modify it.

2. Avoid aggravating activities: Going up and down stairs,walking or running on hills, squating, lifting heavy items andwalking on uneven terrain all aggravate this condition. Try todecrease these by limiting the number of times you go upand down the stairs and avoiding hills. If you must squatdown, keep the affected foot in front and flat on the ground.Do not lift or carry heavy items including your kids. Use astroller or have your spouse, significant other or friend carrythem.

3. Stop running or walking: Aerobic activity is important tomaintain and cross training can help. Try biking orswimming. Most walkers hate the stationary bike at the gym,but remember this isn't forever. Don't drop your heel whenyou bike and try to avoid standing and hills if you cycleoutdoors. If you participate in spin classes, you may need tomodify the class to avoid further injury to the foot. Therecumbent stationary bike may place excess stress throughthe arch because of the position. The classic stationary bikeis more appropriate.

4. Use an ice massage: Freeze a sports water bottle or ajuice can and place it on the floor. Roll your foot over thewater bottle for at least 20 minutes twice a day. This helpsdecrease the inflammation in the foot while stretching outthe arch.

5. Use a contrast bath: Icing helps decrease inflammationoccurring within a 48-72 hour period. To help decreasechronic inflammation, try contrasting between ice and heat.Start with an ice pack on the heel and/or arch for 5 minutes.Switch to a heating pack or a hot water bath for 5 minutes.Alternate between the two for 20- 30 minutes 3-4 times aweek. This may be more time consuming than the ice packalone, but can bring considerable relief.

6. Roll a ball under your foot: Take a tennis ball, soft ball oreven a rolling pin and roll your foot over it to help stretch outthe plantar fascia. This can be done while watching TV orreading the paper. Rolling the foot over the tennis ball canalso be done at work if you have a desk job or during alunch break. (This should not cause pain. Don't continue ifyou have pain).

7. Stretch your calf in the morning: If you have pain in themorning upon waking, place a towel or a belt on yourdresser. Before you get out of bed, wrap the towel or beltaround the ball of your foot. By pulling the foot towards youand keeping your leg straight, you should feel a stretch inthe back of the calf. This will also stretch the bottom of thefoot. This is not time consuming or difficult to do, but it doesrequire adjusting to a new routine.

8. Stretch your calf throughout the day: Spend about 5-10minutes each evening stretching the calf as describedabove or with the runner's stretch. To really help keep thecalf and the bottom of the foot stretched out, try and stretchfor 30 seconds, 10 times a day.

9. Take anti-inflammatory medications: Anti-inflammatorymedications, like naproxen or ibuprofen, will help decreasethe inflammation that occurs in the fascia as a result of thetearing. You don't want to mask the pain with thesemedications. If you decrease the pain with theanti-inflammatory medications but continue to participate inan activity which causes tearing and inflammation of theplantar fascia, you are not healing. Continue resting, icingand stretching while you take the medications. Take themedication with food and stop taking the medication if youexperience stomach discomfort.

10. Lose Weight: This is probably the last thing you wantedto hear. In fact, there is a good chance that you have gainedsome weight since the onset of your heel pain due to adecrease in activity. But, there is no way around the fact thatincreased weight on the body transmits to the feet.Increasing the stress on the plantar fascia can worsenplantar fasciitis, making it more difficult to treat. Eat smartand try to incorporate aerobic activity which decreases theimpact on the feet.

11. Wear supportive shoes: This step may seem logical, butmost individuals don't realize how many shoes lack support.A supportive shoe will only bend at the toes. Test all of yourshoes and don't assume your running shoe is a supportiveshoe. Take your shoe and flip it over. Grab the toe area andthe heel and try to fold the shoe. If the shoe bends in half,then the shoe is not supportive. Don't go barefoot. Get up inthe morning, do your stretch and then slip your feet in asupportive slipper or clog. See the American PodiatricMedical Association's (APMA) list of approved shoes atwww.apma.org/ seal/sealaccategory.html.

12. Try anti-fatigue mats: These mats help to decrease thestress through the heel and add some shock absorption tothe floor. The mats can be a great asset for employees whowork on a hard surface. You may want to consider them forhome if you spend many hours standing in a workshop or inthe kitchen. See the APMA's list of approved anti-fatiguemats at www.apma.org/ seal/sealaccategory.html.

13. Strengthen the muscles in your feet: Place a thin towelon your kitchen floor. Place your foot over the base of thetowel closest to you. Bring the towel towards you by curlingthe toes and gripping the towel as it slides under your foot.Place marbles on the floor and pick them up one by onewith your toes and place them in a bowl.

14. Wear orthotics: Prefabricated orthotics are semi-rigidinserts that fit into the shoe to help control motion in yourfeet. Controlling abnormal motion in the feet can decreasethe stress in the plantar fascia. Soft inserts available at thedrug store may be comfortable, but they will not help controlabnormal motion.

15. Try a night splint: A night splint holds the foot at 90degrees while you sleep. This keeps the foot and the calfstretched out all night long. Night splints are an effectivetreatment, but can be quite uncomfortable. Some individualshave more luck with the sock night splints than with the rigidsplints. These devices are available online, but may becovered by your insurance when dispensed by your doctor.

If your symptoms persist, see a podiatrist.

Christine Dobrowolski is a podiatrist and the author ofThose Aching Feet: Your Guide to Diagnosis and Treatmentof Common Foot Problems. To learn more about Dr.Dobrowolski and her book visit http://www.skipublishing.com/ .

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