As a family physician I see many patients that complain of heel pain. The classic symptoms of plantar fasciitis is severe heel pain with the first few steps in the morning and then again when first getting up and walking after sitting a while.
The bottom of the foot is called the plantar surface of the foot. Fascia refers to a strong fibrous band of tissue, similar to a ligament. The term “itis” refers to inflammation. For instance, appendicitis is inflammation of the appendix, fasciitis is inflammation of the fascia.
The plantar fascia connects the heel to the base of all five toes. The plantar fascia is also called “the spring ligament” because it acts like a spring and is responsible for maintaining the height of the arch of your foot. As you take a step, the plantar fascia permits the arch to rotate toward the floor (pronate) and flatten out a bit. Pronation, as this motion is called, unlocks all the bones of the mid-foot. This allows the foot to adapt to what ever terrain it happens to be walking (uphill, downhill, on the beach, on a rocky surface etc). At the end of the step the plantar fascia then helps the foot to rotate away from the floor (supinate, the opposite of pronate) and become rigid again so that a forceful push-off can be achieved to propel you forward.
The plantar fascia becomes painful and inflamed if the foot pronates or rolls over too much and stretches out the plantar fascia too much. This excessive stretching causes inflammation where the plantar fascia is attached to the heel. The plantar fascia actually starts to pulls away from the bone and this is what causes the pain. One way that the body protects itself against this pulling away from the bone is to build up more bone in that area. The resulting build-up of bone is called a heel spur. A heel spur sounds painful but usually the heel spur is not what is causing the pain. If you have ever seen a heel spur on an x-ray it looks like a horn of bone growing out from the bottom of the heel. When you see this on an x-ray you wonder how anybody can walk with a heel spur. However many people have heel spurs on x-ray but have no heel pain. The heel pain associated with plantar fasciitis comes from the tearing away of the fascia from the bone and not the bone spur itself.
Why is the pain worse first thing in the morning or when you start walking after sitting for a while? The human body is a rapid healer. When you go to bed or even if you just sit down for a while the attachment between the bone and the plantar fascia begins to heal. However, when you get up and start walking again you tear away the newly repaired attachment and this causes severe pain.
The treatment for heel pain due to plantar fasciitis is a two step process. First you have to heal the inflamed tissue where the plantar fascia attaches to the heel. Then as the inflamed tissue is healing it is important to correct the problem that initially caused the plantar fasciitis and the heel pain.
To reduce the inflammation you should start some taking some type of anti-inflammatory medication such as Motrin® or Aleve®. Ice applied to the heel will also reduce the inflammation. In addition some doctors prescribe what is called a dorsal night splint to heal the plantar fascia. The dorsal night splint is worn at night. The idea is to use the splint to hold the foot slightly flexed up toward your head as you sleep. This allows the plantar fascia to heal in a stretched out position. If the plantar fascia heal in a stretched position the first steps in the morning will not break away the newly healed tissue.
As the plantar fascia begins healing it is essential that the problem which caused the heel pain is corrected. Most heel pain is the result of a biomechanical problem that causes excessive flattening of the arch (hyperpronation) and thus excessive stretching of the plantar fascia. The excessive pronation can be corrected with an arch support. The over the counter cushioning devices are helpful to reduce the pain, help calm things down a bit and allow the healing to start. However in order to prevent the heel pain from returning you have to correct the faulty biomechanics. This usually requires a custom arch support. Custom arch supports will be made to match the exact contour of your foot. The custom arch support will limit the pronation, reduce stretch on the plantar fascia, reduce the heel pain and allow the heel to heal.
For more information please visit Heel Spurs.
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