By Jonathon Wolf, MD
One of the most common foot complaints I see in my practice is heel pain in the form of plantar fasciitis. The typical sufferer complains of weeks to months of sharp pain in the heel, usually starting out of the blue. The pain limits daily activities and can make getting out of bed excruciating. Many describe the first few steps of the morning like being stabbed in the foot with a knife.
Plantar fasciitis involves the degeneration of the thick band of connective tissue that forms the arch of our foot, the plantar fascia. While the exact cause of the degeneration is unknown at this time, we do know it's not caused by heel spurs, despite frequently being misattributed to these bony prominences. Spurs are found in many patients, even those who don't suffer from fasciitis. In fact, most patients with plantar fasciitis have spurs on both feet, but only suffer pain in one of their heels. If spurs were actually the cause of plantar fasciitis, we would see more cases in both feet.
We do know that plantar fasciitis is frequently associated with tight calf muscles, like the gastrocnemius and soleus the two muscles that converge to form the Achilles tendon in the back of our ankle. The Achilles tendon stretches out over our heel bone and continues on the bottom of our foot as the fan-shaped plantar fascia. Factors like age, genetics and activity can lead to the development of contractures tightening of the muscles which can put strain on the Achilles and plantar facscia. Over-pull on these structures is thought to cause small tears in the tissue, leading to pain.
If tightness is the enemy, flexibility becomes our friend when treating plantar fasciitis. In my practice, I recommend stretching regimens that serve to increase flexibility in both the calf and plantar fascia. By stretching the tightened tissues for several minutes daily, patients are able to develop enough flexibility in the previously tightened area that they no longer reach maximum stretch during their everyday activities. The repetitive damage to the tissue diminishes, and so does the pain. While the stretches can take a few weeks to show results, once they start to take effect, the results are often significant and the relief welcome.
Until flexibility improves and symptoms ease, there are other strategies to help with the pain of plantar fasciitis. Over-the-counter pain medications like acetaminophen and ibuprofen can take the edge off the discomfort. Rolling a frozen water bottle under your heel is a common, useful tool. Inserting gel heel pads into your shoes can cushion the impact to the heels and lessen symptoms. Finally, try to avoid barefoot walking. Many of my patients are shocked to realize they are the source of the unnecessary trauma to their feet. As such, I encourage my patients with plantar fasciitis to treat themselves to some house slippers with heel padding.
By gradually increasing the flexibility of the affected foot tissues while treating the symptoms, many patients are able to obtain significant relief from plantar fasciitis without the need for surgery. For the minority of cases unable to be successfully treated non-operatively, there remain effective means of relief in the form of surgery.