If you have a stabbing pain on the bottom part of your heel when you take your first step out of bed in the morning, you know about plantar fasciitis. The pain usually gets better once your foot gets limbered up, but it may return later in the day when you’re exercising…or maybe when you get up from your chair after a long period of sitting.
This type of intermittent heel pain is rarely taken seriously…except by those who have experienced the pain. The Medscape Reference article on the topic optimistically states that “about 80 percent of plantar fasciitis cases resolve spontaneously by 12 months.”
But who has the patience to nurse a seemingly minor injury for 12 months?!?!
Unfortunately, that kind of patience is required. Major league baseball slugger Albert Pujols could not afford to be patient. After playing through his misery for 11 years, he ended up having foot surgery and missing an entire season.
Plantar fasciitis involves a degenerative irritation of the fibrous band known as the plantar fascia that runs across the bottom of the foot, connecting the heel bone to the bones in the mid-foot and toes. Its function is to absorb shock while supporting the arch.
Excess demands of running, walking or load carrying, combined with weakness of the arch, can stretch and create small tears in the tissue. The irritated tissues tighten up during sleep, resulting in the pain felt on those first steps in the morning.
The condition is particularly common among runners, walkers and aerobic dancers who overdo it or try to rev up their training too fast. Other risk factors include being overweight, having either flat feet or a high arch, pronating (with feet rolling inward), having tight calf muscles and wearing shoes that are worn out or don’t fit well.
At first, you might feel only mild pain at the heel bone, typically occurring after rather than during exercise. That is the time to start doing something about it. The longer you wait, the longer it will take to go away.
Stop doing whatever aggravates the pain and rest the heel. That does not mean to stop working out. You can swim, ride an exercise bike, use a rowing machine or elliptical trainer. Ice the heel several times a day. Switch to shoes that are more suitable for your feet. And stretch regularly, focusing on the calf muscle and the Achilles tendon.
The stretching may be the most important part of your treatment. Do it before you get out of bed in the morning and several times during the day.
You can eventually get back to the activity that caused the irritation, but be careful at first and back off again at the first sign of discomfort. The rest gives you an opportunity to start cross training–probably the best long-term preventive strategy.
If your workout shoes have signs of wear, replace them. And be sure the shoes fit well and are appropriate for your gait and foot strike–whether pronation, supination or neutral.
A sports medicine or foot doctor might recommend orthotics, or shoe inserts–either custom-made or over-the-counter. The goal is to correct abnormalities in foot structure and thereby eliminate or reduce the shock that is usually absorbed by the plantar fascia.
Splints to wear at night can also be effective. These keep the foot in a stretched position, making it difficult to point your toes while sleeping.
When pain persists, as it often does, doctors often suggest injections of corticosteroids. Studies have found, however, that the benefit of injections is mostly short term. And the number of injections that can be given is ordinarily limited since they can weaken tissue and lead to additional injuries.
Finally, there are the desperation treatments, usually reserved for severe cases and elite athletes who can’t afford the patience required.
Extracorporeal shock wave therapy has been used to treat soft-tissue and bone-related problems for more than 20 years. At high doses (but not at low doses), some studies have found it effective in relieving symptoms of plantar fasciitis. Another form, known as radial shock wave therapy or radio pulse therapy, has a less penetrating effect on tissue, but it too has shown some beneficial effects. The final option is surgery. This generally results in a weakening of the arch in the foot. But athletes who have lived with pain for many years, may be willing to accept the side effects.
Patience is the word. If you have enough patience and are willing to rest, ice and stretch your foot as prescribed, the pain will nearly always fade away…within 12 months or so.
If you think you might have plantar fasciitis, call your primary care physician. The earlier a doctor diagnoses and treats your problem, the sooner you will have relief from pain.
If you don’t have a doctor you can find one at Ministry Health Care or Affinity Health System.
Coach Adam, “Plantar fasciitis,” racewithpurpose, July 16, 2007.
Patrick M. Foye, M.D., “Physical medicine and rehabilitation for plantar fasciitis,” Medscape References, updated July 19, 2015.
Mayo Clinic Staff, “Plantar fasciitis,” MayoClinic.com, February 27, 2014.
Patrick O. McKeon, et al, “The foot core system,” British Journal of Sports Medicine, 2015;49(5):290.
David Leon Moore, “Plantar fasciitis knocking top athletes off their feet,” USA Today, August 21, 2013.
“Plantar fasciitis: topic overview,” WebMD Medical Reference from Healthwise, last updated November 14, 2014.
“Plantar fasciitis,” MedlinePlus, updated by C. Benjamin Ma, M.D., March 8, 2014.
Cathy Speed, “A systematic review of shockwave therapies in soft tissue conditions,” British Journal of Sports Medicine, 2014;48(21):1538-1542.
“A step in the right direction,” FootCare MD, American Academy of Orthopaedic Surgeons.
“Treatment of plantar fasciitis takes patience,” Nurse.com, Kathleen Louden, April 16, 2009.
Craig C. Young, M.D., “Plantar fasciitis,” Medscape Reference, updated October 11, 2015.