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Heel Pain - Ten Tips for Treatment
The most common cause of heel pain is plantar fasciitis(plan * tar fash* ee * I * tis). If you experience a sharp painin your heel when you first step down in the morning, it ismost likely due to plantar fasciitis. This type of heel painmay also occur as achiness at the end of the day in the heelor even burning pain in the arch. Plantar fasciitis can beassociated with a heel spur, but this is not the cause of thepain. When the long ligament like structure (plantar fascia)on the bottom of the foot pulls on the heel bone over aperiod of time, a spur is formed. Only 50% of individualswith plantar fasciitis have a bone spur in their heel. Thespur will never go away, but the plantar fasciitis will. Plantarfasciitis is typically caused by a new activity, a new pair ofshoes, a worn out pair of shoes, a change of routine orchange in job. Individuals with flatfeet or abnormal motion inthe feet may have a higher chance of developing plantarfasciitis. Once you develop plantar fasciitis, you may find itvery difficult to treat.
1. Identify the cause: There is typically a reason for thedevelopment of plantar fasciitis, but since the condition isnot typically associated with an acute injury it may be hard toremember. Once the cause is identified, try to stop or modifythe activity.
2. Decrease aggravating activities: Climbing up and downstairs, walking or running on hills, squatting, carrying heavyitems and walking on uneven terrain all place excess stressthrough the feet. Decrease these activities by asking yourspouse, significant other or friend for help with the kids orcarrying heavy items. Avoid multiple trips up and down thestairs at work and home. Limit gardening to flatter moreeven terrain. Stop running and walking for exercise and trybiking or swimming. Avoid the stair stepper, the treadmilland the elliptical machine at the gym.
3. Stop running or walking: Keeping up aerobic activity isimportant and cross training can help. Try biking orswimming. Most walkers hate the stationary bike at the gym,but this isn't forever. Don't drop your heel when you bike andtry to avoid standing and climbing steep 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 bikemay be more appropriate.
4. Try using an ice massage: Freeze a sports water bottleand place it on the floor. To decrease inflammation and painin your arch, roll your foot over the water bottle for at least 20minutes twice a day. Alternate between the frozen waterbottle and a heating pad, at 5 minute increments, for 20-30minutes a day, three to four times a week.
5. Stretch your calf: Before you get out of bed, wrap the towelor belt around the ball of your foot. Pull the foot towards you,keeping your leg straight. You should feel a stretch in theback of the calf, and this will also stretch the bottom of thefoot. Stretch your calf throughout the day with the runner'sstretch and spend 5-10 minutes every evening stretchingyour calf.
6. Take anti-inflammatory medications: Anti-inflammatorymedications will help decrease the inflammation thatoccurs in the fascia as a result of the stress and tearing.Make sure you decrease your activity level and stretch andice as much as possible during the time you are takingthese medications. Otherwise, you may end up onlymasking the pain. Take the medication with food and stoptaking the medication if you experience stomach discomfort.
7. Wear supportive shoes: A supportive shoe will only bendat the toes. This step may seem logical, but manyindividuals don't realize that their comfortable shoes lacksupport and may be contributing to their pain. Test yourshoe by taking it, flipping it over and grabbing the toe areaand the heel. Attempt to fold the shoe in half. If the shoebends in half, then the shoe is not supportive. Don't gobarefoot. See the American Podiatric Medical Association's(APMA) list of approved shoes at www.apma.org/seal/sealaccategory.html.
8. Strengthen the muscles in your feet: Place a small towelon the floor and curl your toes on the towel as you bring thetowel towards you. Place marbles on the floor and pick themup with your toes and place them in a bowl.
9. Wear orthotics: Prefabricated orthotics are inserts that fitinto the shoe to help control motion in your feet. Controllingabnormal motion in the feet can decrease the stress andhelp the plantar fascia heal. Soft inserts available at thedrug store may be comfortable, but they will not help controlabnormal motion. Make sure the orthotics you buy are rigidor stiff from the heel to the ball of the foot.
10. See a podiatrist: If your symptoms persist, make anappointment with your podiatrist. Other treatments includeprescription anti-inflammatory medications, steroidinjections, night splints, physical therapy, cast boots, shockwave therapy and surgery. Luckily, very few individuals needsurgery.
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. For more information on howto treat heel pain visit http://www.northcoastfootcare.com.
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