Painful Heel - Plantar Fasciitis

Plantar fasciitis is one of the most common heel pain conditions. It is the inflammation of a thick band of tissue called plantar fascia attached to the heel bone and base of toes. Plantar fasciitis causes stabbing pain in the heel, especially in the morning time and subsides after some painful walking. It is common in runners and in those who wear non-adjustable footwear or in those who are obese. 

Causes

Causes of plantar fasciitis include excessive running, flat feet, standing on hard surfaces or wearing unsuitable footwear and high arches of feet. Actually plantar fascia works as a shock-absorber and when tension is increased, small tears occur in its tissue leading to inflammation and heel pain.

Tests

Usually, no test is required and the diagnosis is clinical. However, physicians may advise x-ray foot or magnetic resonance imaging (MRI). X-ray foot may show bony spurs.

Treatment

Treatment of plantar fasciitis is simple and easy. Just rest your feet and cut your daily activities. Reduce your extra pounds if you are obese. 

Painkillers

Painkillers like NSAIDS (e.g. Ibuprofen) relieve pain and inflammation in most of the cases.

Physical Therapy

Physical therapy includes several types of exercises before getting out of bed. One can perform the following exercise in the morning before getting out of bed:

1. Scrunch and splay - Flex and extend your toes, keeping the ankle joint still. Do it thirty times.

2. Ankle pump – Flex and extend at the ankle joint, keeping the toes still. Do 30 repetitions.

3. The roll-out – It is a kind of massage. Place a soft ball under your feet and roll your feet over it, applying minimum to moderate pressure in sitting position and moderate to high pressure in standing position. Do 30 repetitions.

4. Self mobilization – Support your heel with your left hand and perform flexion and extension at toes with your right hand. Do it 30 times.

5 & 6. Heal and toe raise – Raise your toes and heel in alternative manner. It means raise the distal part of your foot extending the ankle joint and then raise the proximal part of your foot extending the toes. Do 30 repetitions in sitting position and 30 times in standing position.

(Why to do the above exercise before getting out of bed? It prevents the plantar fascia from getting irritated while walking or in weight bearing position. It offers two benefits: increases blood circulation to the plantar area and extensibility to the tissue).

Night Splints and Orthotics

Your physician may advise you to wear night splints and orthotics. These night splints stretch your plantar fascia and Achilles tendon, and prevent them to get tight at night.

Steroid Shots

Steroid injections are given to those with chronic plantar fasciitis. Injection is given into the painful plantar area. Options for steroid injection include Celestone (Betamethasone) 6mg (1ml) or Solu-Medrol (Methylprednisolone) 40mg (1ml).

Extracorporeal Shock Wave Therapy

In this therapy, sound waves are directed to the painful plantar area to enhance the healing.

Surgery

Surgical treatment is reserved only for those who do not respond to medical or conservative management.

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Keywords: Plantar fasciitis, Painful heel, Treatment, Physical therapy, Exercises, NSAIDS, Painkillers, Ibuprofen, Night splints, orthotics, Extracorporeal shock wave therapy, Surgery