• Heels That Hurt

    image Most pain associated with the heel can be tied to one disorder: plantar fasciitis . The plantar fascia is a long, thin ligament in the bottom of your foot that connects the heel to the front of your foot and helps support your arch.
    Forces acting on the foot while walking or running cause the arch to flatten out. At the same time, the plantar fascia is trying to keep this from happening. These opposing forces put tremendous stress on the tissue. When enough continuing stress exceeds the body’s ability to heal itself, the tissue under the heel becomes injured and painful.

    Symptoms

    The symptoms of plantar fasciitis include severe pain, especially first thing in the morning. Most people say that it hurts from "the instant their heel touches the ground." Some even feel pain and stiffness when starting to walk after sitting for a while.
    Plantar fasciitis is often seen in persons over 40 years old or in those who are overweight. There is also an increase in visits to doctors during the spring and summer months as people resume activities involving walking or running. Among runners and other athletes, shoes that do not support the foot properly commonly lead to plantar fasciitis.

    Diagnosis

    Diagnosis is most often made by assessing the place (middle of the bottom of the heel) and timing (eg, early morning) of the pain. The doctor will also question you on your activity levels and your weight.
    While fractures , infection, and arthritis can also occur, the place and timing of the pain is usually different. Sometimes an x-ray or other imaging test is needed to exclude these other causes.

    Treatment

    Over-the-Counter Remedies

    Some treatment options include:
    • Avoid activities that cause a pounding of the foot. Bicycling and swimming are good alternatives for exercise during this time.
    • Perform calf stretches and plantar fascia stretches
    • Switch to a good pair of shoes.
    • Try using over-the-counter shoe inserts.
    • Put ice on the heel for 20 minutes, three times a day. Other options include special Blue Ice gel packs available at most pharmacies and many running supply stores.
    • Use a non-steroidal anti-inflammatory medicine (eg, ibuprofen, naproxen). Follow the directions on the label or those given by your doctor.

    Other Treatment Options

    "Stretch splinting” at night can be tried to improve symptoms and reduce the duration of activity limitation. Other treatments could include:
    • Physical therapy
    • Steroid injections or botox injections in the heel
    • Shock wave stimulation
    • Cast to keep the foot immobilized
    • Surgery as a last resort

    RESOURCES

    American Orthopedic Foot and Ankle Society http://www.aofas.org/

    American Podiatric Medical Association http://www.apma.org/

    CANADIAN RESOURCES

    Canadian Podiatric Medical Association http://www.podiatrycanada.org/

    Podiatrists in Canada http://www.podiatrycanada.org/

    References

    Heel and arch pain. Foot and Ankle Center website. Available at: http://www.footankle.com/heel-arch-pain2.htm . Accessed September 4, 2008.

    Plantar fasciitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated October 20, 2011. Accessed May 10, 2012.

    Plantar fasciitis and bone spurs. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00149. Updated June 2010. Accessed May 10, 2012.

    Zeltser R. Plantar fasciitis. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated September 1, 2011. Accessed May 10, 2012.

    Zeltser R. Discharge instructions for plantar fasciitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 1, 2011. Accessed May 10, 2012.

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