My Heel Is Killing Me… I Can’t Walk… What Is It?
By Nathan Wei

A not uncommon scenario is the sudden development of pain in
the bottom of the heel.

This sharp stabbing pain has a name… plantar fasciitis.
Oftentimes, it will come on when a person gets out of bed in the
morning or when they get up out of their chair at breakfast. On
other occasions, it can come on slowly. Regardless of the mode
of presentation, it feels as if someone were jabbing an ice pick
into the heel.

The plantar fascia is a tough band of tissue that runs from the
bottom of the calcaneus (heel bone) to the base of the toes
(ball of the foot). The purpose of the plantar fascia is to help
absorb shock and support the arch. However, if the fascia is
injured, small tears can develop leading to inflammation and
irritation.

Stretching can reduce the pain but prolonged inactivity such as
sleeping or sitting in a chair for an extended period of time
causes the fascia to tighten. And when one gets up to walk, the
fascia is stretched and the tears become irritated again.

What causes plantar fasciitis? Risk factors include excessive
weight, abnormal arches (either too high or too low), age,
improper footwear with no arch support, excessive training (eg.,
long-distance running), and trauma.

Probably the best treatment is avoidance.

Proper footwear can be helpful in preventing the onset of
plantar fasciitis. Shoes that provide good arch support and
shock absorbency are advised. For women, heels can be worn but
they should be no higher than three inches. Varying the height
of the heel on a daily basis is also a good idea.

Runners should replace their running shoes on a regular basis.
A quick way to tell is to bend the shoe. If the shoe bends
easily, then the shoes need to be replaced.

Stretching of the feet, calves, and Achilles tendons is one
good way to avoid an occurrence … or reoccurrence of plantar
fasciitis. Stretching should be done 2-3 times a day.

Avoiding extra poundage is key. There is a correlation of
plantar fasciitis with obesity.

However, if plantar fasciitis does develop, then the important
thing is to recognize the symptoms as soon as possible so that
proper treatment can be instituted. Once it starts, plantar
fasciitis can be very persistent.

Podiatrists often recommend taping or strapping as the first
line of treatment. This procedure works because it rests the
plantar fascia. And lets the tears heal.

Patients should not stretch at first. After a brief period of
rest, they may begin stretching the arch, toes and Achilles
tendon. This is a routine they'll need to follow faithfully for
many months, even after symptoms subside.

Patients should limit the amount they walk and eliminate all
high-impact activity such as running. Arch supports will also be
needed.

Inexpensive inserts available at pharmacies and running shoe
stores are effective if they are arch-supportive and rigid.

Sometimes, though, the issue is due to abnormal gait.

Gait problems must be corrected with special customized
orthotic inserts. A podiatrist is needed to make sure these fit
properly.

Sometimes, a special foot and ankle splint is used at night to
stretch out the fascia and Achilles tendon. While simple
versions of these are available from specialty retailers, it is
best to seek professional evaluation and fitting through a
licensed provider such as a trained podiatrist.

For pain relief, patients may be prescribed non-steroidal
anti-inflammatory drugs (NSAIDS). Opinions vary as to whether
ice or moist heat is more effective.

In patients who do not respond to conservative measures, a
glucocorticoid (steroid) injection may do the trick. Ultrasound
needle guidance is recommended to ensure, the proper location is
injected. No more than two injections should be given since
weakening of the fascial tissue with subsequent rupture can
occur.

Surgery is a last resort measure. Newer endoscopic techniques
may be less traumatic to tissue.

About the Author: Nathan Wei, MD FACP FACR is a rheumatologist
and Director of the Arthritis and Osteoporosis Center of
Maryland. He is a Clinical Assistant Professor of Medicine at
the University of Maryland School of Medicine.
http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html

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