By Ryan Jones, DPT, CSCS
It's reported by the National Institute of Health that upwards of 10% of the population will experience some form of heel pain in their lifetime that will cause them to seek medical help. Among those who are regularly active with exercise and running, the prevalence of these cases increases greatly. The most common cause and diagnosis is plantar fasciitis, which is something you may have heard of but never fully understood.
What exactly is your plantar fascia and what does it do?
This term refers to a broad, tight ligament that starts along the bottom of your foot at the heel bone, called the calcaneus, and extends forward to attach to the metatarsals. This band creates the primary passive support system for the arch of your foot. With repetitive stress or trauma, the attachment of this ligament at your heel becomes inflamed and sustains a strain or micro tears, which causes pain. Plantar fasciitis is common in people with excessively flat feet (overpronated), as well as those with excessively high arches (oversupinated). Others risk factors include being overweight, having a job that requires prolonged standing/walking, wearing unsupportive footwear, and tight calf muscles. Plantar fasciitis is also very common in the running population due to the repetitive stress involved with jogging.
The common presentation of plantar fasciitis is severe heel pain -- like stepping on a hot knife -- with the first few steps out of bed in the morning. The pain typically dissipates once you stand and move around, warming the tissue. Pain can normally be re-created by pushing on the inner portion of the heel bone where the micro-tearing has occurred.
Say goodbye to heel pain
The key to preventing your pain from becoming worse - even getting rid of it entirely - demands you stop the pain cycle. Think about it. With each step out of bed in the morning, you are creating additional micro tears in the fascia as you traumatize cold and injured tissue. So, you need to stretch/massage your plantar fascia, as well as your calf muscle, BEFORE standing up in the morning.
Equally important to the healing process is wearing proper footwear, and avoiding walking barefoot. Proper footwear options include supportive athletic shoes, or other styles of shoes with an orthotic placed inside. Uggs or those really comfy foam slippers DO NOT count as good footwear.
Other common treatments include: avoiding any impact or painful activities for a period of time, strengthening the foot/ankle muscles to help support your arch, performing a specific type of massage called transverse friction, receiving cortisone injections, or using anti-inflammatory medications and ice. Night splints may also be helpful.
While plantar fasciitis is the most common cause of heel pain, it is important to note that it may be another problem so it is always wise to see your doctor or PT for a more accurate diagnosis. The key to success with heel pain is early intervention. The quicker you recognize and address the pain, the faster it is likely to go away. Chronic plantar fasciitis can swiftly become debilitating and lead to several months of rehabilitation and exercise restriction.
Remember these three keys for HEELing: early diagnosis, stretching in the morning before getting out of bed, and wearing proper footwear.