Heel Pain In Plantar Fasciitis

Do you ever get out of bed in the morning and have severe heel pain? Does this pain improve after activity and then worsen after you’ve been sitting a while? I did, and it was a horrible knife-like stabbing pain in my inner heel area. I am not one to run to the doctor, but this was not going away on its own, so I made an appointment with a local Podiatrist.

Common complaints for the diagnosis of Plantar Fasciitis are a “stabbing pain” in the heel that occurs with your first steps in the morning. A tightness or stiffness will also be apparent as well as some warmth, and swelling. As you get up and move about, the pain will normally decrease. But the heel pain will return after long periods of standing or when you stand up after sitting for long periods. The pain can be described as “walking on broken glass.” Yes, that is exactly how I would describe it.

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What is it?

Plantar Fasciitis is one of the most common causes of heel pain. “Plantar” refers to the sole of your foot.  Plantar fasciitis is the chronic inflammation of the “bowstring-like” ligament (fascia) stretching underneath the sole, that attaches at the heel. This tough, fibrous ligament connects your heel bone to the base of your toes. The fascia supports the arch of your foot and absorbs shock when you walk. Stress and repeated stretching and tearing can become too much for the fascia, and can irritate it and inflame it.

Risk Factors

• Age. Plantar Fasciitis is most common between the ages of 40 and 60. I was 54 at the time I was diagnosed. As you age, your feet widen and flatten making it increasingly difficult for the arch of the foot to distribute weight and impact properly. This leads to strain and damage. This flattening can also cause the heel fat pad to wear out more quickly. Without this padding, more stress lands on the heel bone and arch.
• Obesity. Excess pounds put extra weight and tension on your heel bone and arch, also causing more strain and damage.
• Certain activities. Activities such as running, ballet or aerobic dancing, and frequent walking can put extra stress on your heel and the attached tissue. Also, constant sitting can be a contributing factor.
• Foot mechanics. A high arch, which I do have, flat feet, or an abnormal way of walking can affect the weight distribution on your feet. Some people’s feet roll inward too much when they walk, which is called pronation. All these factors can increase stress on the fascia and its connections.
• Occupations. Nurses, teachers, clerks, or any other person who spends most of their work hours walking or standing on hard surfaces can cause strain and eventual damage and scarring to the fascia. I’m a Registered Nurse, and am constantly on my feet in the hospital setting.
• Shoes. If you wear flat fitting shoes, slippers, or sandals that have no arch support, the fascia is constantly stressed with every step you make. Flat fluffy slippers were indeed a factor in my developing plantar fasciitis. On my days off, I wore these flat, poor supported, but warm, slippers from morning till nightfall.

Diagnosis

Diagnosis is based on both your medical history and physical examination. During the exam, your health care provider will check for areas of tenderness in along the sole of your foot. Most commonly, the tenderness is felt along the inside arch of the heel. When I visited my Podiatrist, he pin-pointed the involved area quite quickly. There was no need for further tests. I was given a print out with my treatment plan.

Treatment

Most people recover in a few months with conservative treatment such as rest, stretching, and icing the painful area. Pain relievers such as ibuprofen or naproxen (Aleve) will ease pain and inflammation. What will help the most are therapies geared to easing the irritation and damage of the fascia.

Physical Therapy can help with specific exercises geared towards stretching the plantar fascia, Achilles tendon, and exercising the lower leg muscles. Often, normal gait is disturbed when pain occurs in the heel area, leading to additional back or leg pain. Eventually these too will improve as the pain in your heel dissipates. These stretches can help alleviate some of the tightness in your leg and heel areas. Remember to do each exercise slowly and gently as the fascia can be quite inflamed. I did not sign up for Physical Therapy but practiced the stretches above to help decrease the tightness and add more flexibility to my foot.

Night splints are very helpful in stretching your calf and the arch of your foot while you are sleeping. The splint holds the plantar fascia and the Achilles tendon in a lengthened position to promote stretching. Splints are best worn until the pain and inflammation have improved and the fascia is back to normal functioning. I ordered a splint and wore it faithfully. It was indeed one of the best things I did when working towards my recovery.

These night splints have been used successfully in the recovery of plantar fasciitis. I used the one pictured in the second image.

Orthotics are very helpful in distributing pressure to your feet more evenly. Orthotic shoe inserts are used to reduce the excess motion of the foot and decrease strain to the plantar fascia. Often, a podiatrist will recommend over-the-counter ones to use in the overall treatment period to help give the fascia a rest and heal.

This shoe orthotic, the Powerstep Pinnacle, works well in any sneaker. Simply remove the insole of your shoe and insert this orthotic. There is an immediate relief of the strain caused on your inflamed and irritated fascia when wearing these. Even though I have healed, I continue to use these specific orthotics as they provide me with great support of my arch and also prevent the pronation I tend to have when walking.

Follow the link below to the Powerstep Pinnacle orthotic insert and select your size.

Best Fitting Shoes

There are options other than wearing sneakers with the inserts. It helps to select shoes that provide great arch support, have contoured foot beds to help promote proper alignment, have deep heel cups for stabilization and shock absorption, and/or have removable soles for those requiring additional custom or over-the-counter orthotics. For instance, Stegmann Clogs are ideal for wearing in your home instead of flat slippers. I wear these whenever I’m home. They provide excellent arch support and are very comfortable. They are also go well with jeans and dress pants.

If you like to wear sandals, there are several orthotic brands that can help provide proper support. Regular flat flip flops or sandals will only cause more irritation and stress on your foot. I have a pair of Vionic sandals which offer what I need for my high arch. Clark’s also provides sandals and shoes that help keep your foot in proper alignment while providing needed support. Here are some choices that are both stylish and yet comfortable.

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Dansko is a top footwear choice for those who spend most of the day on their feet.

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Over time, while practicing these techniques, you should feel a gradual healing of your fascia. You will have less pain, a more stable gait, and feel more comfortable walking and standing. Years later, after my bout with plantar fasciitis, I continue to wear the Powerstep Pinnacle Orthotic in my sneakers when working or walking. I also always make sure I wear dress shoes with good arch support. I have had no further pain or inflammation since I have followed the techniques handed to me on the day I saw my Podiatrist.

In some cases, when pain is severe or doesn’t respond to prescribed NSAID’s, you may opt to have your doctor inject your fascia with a steroid. This may help ease your pain for about a month, but it will keep the inflammation down for even longer. Then you could continue with conservative treatment described above to help keep long term discomfort away and be free of plantar fasciitis.