The most common cause of chronic heel pain is called Plantar Fasciitis (PF). This is also the most common condition that presents to my office.
The plantar fascia is a very large ligament that attaches to the heel bone and runs all the way up to the ball of the foot. This ligament is the primary supporter of the foot’s natural arch. It acts like a rubber band that prevents the foot from over-flattening when your body weight is applied during standing, walking, and running. PF is inflammation of the plantar fascia due to small tears within the fascia.
People that are susceptible to PF include: 1) people with recent and/or rapid weight gain and/or people with a high body mass index; 2) people who run and walk for exercise; 3) people with occupations that require a lot of standing and/or walking; and 4) people who wear unsupportive or worn shoes. If your foot has too much weight/impact applied to it from any of the four reasons mentioned above, small tears will occur.
Most of the time, this condition develops slowly without any history of injury. The condition can also develop suddenly as a result of traumatic injury but that is rare. Many people first experience a dull ache that starts in the mid-arch. It has been described as feeling like a stone is in the shoe. As the condition worsens, it may move toward the heel. Often patients say that it hurts most when walking or standing after periods of rest. In less severe cases, the pain may ease with some walking or running. Over time, this easing of symptoms takes longer and longer to occur and eventually it’s painful all the time.
Most cases of PF can be treated without the need for surgery. When patients initially present to my office with PF, the visit usually focuses on activity modification, shoe wear, and stretching advice. In addition, a medical grade arch support is usually dispensed. If this initial treatment fails, then we may consider a cortico-steroid injection, a night splint, and/or physical therapy. Custom orthotics are also an option. Surgery is a last resort. In my experience, surgery is only needed in about 1 of 50 cases.
Good shoes are a very important part of curing PF. A good shoe is one that combines cushioning and support. Running sneakers are generally the shoes that do this best. A supportive shoe is one that bends only in the toe box. The shoe should also resist an effort to twist from end to end. A cushioned shoe is one that employs some type of shock-absorbing midsole. For more information on shoes, see my previous philly.com article titled “What is the right athletic shoe for you?” Someone with PF should ideally wear a good running shoe for all periods of standing and walking until pain has subsided. There are supportive dress shoes but they are much harder to find. Higher end dress shoes have started making their shoes with a removable insole that comes with the shoe. This allows one to remove the stock insoles (which usually are not very supportive) and replace it with a medical grade arch support if needed. At a minimum, you should make sure that your dress shoes have readily removable insoles rather than glued insoles. Supportive dress shoes for women can be even harder to find because, more often than not, form trumps function in women’s shoe wear.
Barefoot walking should be avoided. When at home, if you don’t like to wear shoes when in the house I usually suggest my patients get a supportive pair of sandals. “
Brands that I have endorsed are Birkenstock, Abeo, Spenco, Vionic/Orthaheel, Sole, and Fitflops. A simple pair of slippers, flip flops or crocs Chiropractic will not be supportive enough and they are likely to make the situation worse. An effort should be made to stand and walk less while the heel is still painful.
While PF can be a very tricky condition to treat, following the steps discussed in this article and the advice of your doctor can get you up and running again, pain-free.
Dr. Crispell is a foot and ankle specialist at Riddle Hospital in Media, PA. He is a guest contributor to Sports Doc.
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Published: March 9, 2016 — 4:00 AM EST
| Updated: March 9, 2016 — 4:45 AM EST