Plantar Fascitis (Heel Pain)
ICD-9: 728.71

  Heel pain is a common condition involving the foot. It can be quite disabling but when caught early and treated aggressively it can often resolve within a short period of time.

  The most common cause of heel pain is called plantar fascitis. The plantar fascia is a thick fibrous tissue, which attaches to the heel bone and fans out to attach to the base of the toes. It acts like a bowstring to help maintain the arch of the foot. Heel pain often times begins when repeated stress on this inelastic ligament causes inflammation into the area of attachment to the heel. This increased stress is often caused by abnormal foot motion called pronation. Increases in activity in a walking or running program, tight heel cords, excessive pronation (foot rolling in), worn out shoes or being overweight may play an influence in the development of plantar fascitis. Pain is usually located directly on the bottom of the heel where the ligament attaches to the heel but can also extend out to the arch region. The pain is usually at it’s worse in the morning during the first few steps or during the day after sitting and then initially getting up to walk.

  This painful inflammatory process may eventually cause a heel spur (spike-like projection) on the under surface of the heel bone. This spur typically occurs as a response to long-term stress in the plantar fascia and is not the cause of heel pain. X-rays are rarely needed to diagnose or treat plantar fascitis. About ten percent of adults who have never experienced heel pain have heel spurs.

  Treatment of plantar fascitis consists of correcting the underlying biomechanical causes and reducing inflammation. Treatment can begin prior to visiting a physician and generally will consist of the following remedies:

• Activity Modification: Temporarily stop exercises that place stress on the plantar fascia like walking, running, Stairmaster and Nordic Trac. Cross train with activities like stationary and recumbent bikes, deep-water aerobic programs and rowing machines. These activities can keep you cardiovascularly fit while providing little stress to the plantar fascia.


• Avoid walking barefoot or the use of stocking feet and slippers around the house. Keep supportive shoes on at all times and keep them at your bedside.


• Wear new supportive shoe gear like athletic or casual style shoes. Not all shoes provide the supportive features you'll need to get better. Avoid wearing heels or flats. Try to wear shoes that have strong heel counters and that have lace or buckle style closures. Local specialty retail shoe stores have the technical expertise in helping you to find the shoes for your specific foot problem.
  
  San Luis Podiatry Group recommends the following local shoe stores:
  
  • Takkens
  • Charles Shoes
  • The Shoe Tree
  • Mike's Shoes


• Avoid walking barefoot or the use of stocking feet and slippers around the house. Keep supportive shoes on at all times and keep them at your bedside.


• Purchase an over-the-counter arch support to be worn in your shoes at all times. Arch supports (orthotics) can be uncomfortable when you first use them. It's advisable that you break them in slowly by wearing them initially for one to two hours the first day then increasing gradually over a several day period. Many orthotics are cushioned but to control abnormal pronation a stiffer orthotic is need. Recommended orthotics include: Spenco Moldable Arch Supports or Birkenstock Orthotic. These arch supports can typically be purchased at the recommended specialty shoe stores.


• Stretch the calf and heel cord, slowly holding for 30 seconds on each side and repeating. Try to stretch at least twice daily.


• Deep tissue massage at the point of maximal tenderness may be helpful. An easy way to do this is place your foot on a golf ball and roll it on your painful heel for several minutes.


• Over-the-counter anti-inflammatory medications like ibuprofen (Advil or Motrin) can be used as directed if no history of allergy or ulcer has been experienced. This medication needs to be consistently taken for at least seven to ten days as directed by your physician for it to be effective.

    The combination of the above treatments, if done faithfully, can help significantly with plantar fascitis. If the pain is severe enough a cortisone injection can be extremely beneficial also. The use of walking casts, night splints and physical therapy may be needed in difficult cases. Conservative treatment is successful 95-98% of the time. If symptoms persist despite your initial treatment or if you are experiencing numbness, tingling or burning pain to the heel or bottom of your foot, contact your primary care physician or specialist for further evaluation.