One day you are minding your own business. You wake up and it feels like you stepped on a stone. Sometimes it can be as like stepping on a spike. You look at the bottom of the heel and see nothing that would cause this problem. After a few steps it feels better and you go on about your day. Whew… glad that was over. But wait. You get ambushed again after you sit down for lunch or after driving home from work.
The pain in the bottom of your heel is not just a one-off coincidence. It is becoming more frequent and increases with activity. This type of heel pain is a nuisance, a distraction, and slows you down. Regardless of your age, no one wants to walk like “an old person”. Even though it feels like this pain just occurred it has actually taken a very long time to develop.
You might not know the term “plantar fasciitis” very well, but you may know the feeling of dread many people have every morning at the thought of putting their feet on the floor. (Perhaps you’re one of them!)
People tell me (Dr. Leibovitz) they have tried “everything” to get rid of their pain – all the “Web MD” and Doctor Google suggestions. They have new shoes, listened to Grandma Lilly’s remedies, used ice massage, rolled tennis balls or a frozen water bottle under their foot, foot soaks, and NSAIDs. And they may have helped for a while. These treatments may be helpful for the moment but they do not change how your heel feels next week or next month.
You can use ice, pressure, massage, and NSAIDs when you hit your thumb with a hammer. There will be some immediate relief. But if you hit your thumb every day these treatments will not make a difference in the long run.
What is Causing Your Heel Pain?
So what did you do to deserve this? Most likely you chose the wrong parents, gained a little too much weight, increased the number of daily steps, or any combination. You cannot change your parents (there is a strong family trait for foot function) and weight loss is very tough without activity.
You should not have to stop activity to improve the heel pain (and it will return as soon as activity returns). There is one area that can make a big difference–how the foot works, aka biomechanics. This is an easy and simple thing to improve.
Although heel pain may be new to you it is something that we see every day. There are times when it feels like heel pain central in my office. You are dealing with a thick and strong band of connective tissue that runs the length of the foot, and one of the most common culprits is plantar fasciitis.
The plantar fascia is a thick band of tissue that runs along the bottom of the foot. It helps form the arch and flexes as you move, storing and releasing energy.
While strong, it’s not invincible. Excess strain on the tissue can cause very tiny tears to develop in it, which then leads to pain and aggravation. This strain can be caused by factors including:
- Overuse, which can come from pushing yourself too hard during activity without proper warm-ups or rest.
- Working in an environment that places excess pressure on your feet, such as standing or stooping on hard surfaces all day.
- An abnormality in foot structure (such as flat feet) that shifts your body weight improperly.
- A tight calf muscle causes your Achilles tendon to excessively pull on your heel bone and plantar fascia.
So why is there more pain in the mornings or after sitting for a while? Because of the flexibility of the plantar fascia. When you rest for a long period, the plantar fascia ends up losing temperature and flexibility. When you start moving again, it has to stretch and flex once more. After “warming up” sufficiently, the pain tends to improve or vanish.
If you pull your toes upward you will see the plantar fascia bow out from the arch. The weak spot of the plantar fascia is the attachment point at the bottom of the calcaneus. 9.5 out of 10 people will point to this specific location. 7 out of 10 people hurt more when they begin walking than after being more active. 8 out of 10 people will report a pain level of 4-8 out of 10. 100% of people with plantar fasciitis want it over as soon as possible and never to return again.
But you don’t have to just hobble around and endure the pain until it lessens. There are effective ways to get to the root of your heel pain and address the problem.
Treating Plantar Fasciitis
Unfortunately, there is no overnight miracle that will turn this around. It takes motivation (pain is a great motivator) and dedication to beat plantar fasciitis.
The first step is to change the biomechanics. If you pass this test we can consider long-term control of the foot mechanics with custom orthotics. In addition to bad foot mechanics, there is the evil force of a tight Achilles tendon that needs to be dealt with.
The Achilles is a significant problem. It takes years for this tendon to tighten up and it will take months to stretch it out. If your plantar fasciitis pain returns, it is most likely because of the Achilles tendon. This is where dedication comes in. Once symptoms are relieved it is easy to forget about all the hard work that got you better. If stretching stops, the pain comes back.
I know this very well – I am a member of the Blue Block Club. (You know what that is if you are one of my patients). I will feel the agony of defeat (or the feet) if I fall off the wagon and fail to do my daily stretching. Yes, more bad news. Treating plantar fasciitis is like rolling a bowling ball uphill. It will need a little ongoing attention. If distracted, the problem will reoccur and we have to start at the bottom of the hill again, and again, and …
Yeah, that does not sound too encouraging. The good news is that treatment is pretty easy and simple. I wasn’t thrilled when I was told that I would have to use glasses or contacts for the rest of my life. Well, I got used to them and I don’t really think about using them anymore. I did have the option for eye surgery but as a surgeon, I knew that a poor result would be the end of a career.
Speaking of surgery, I can also perform a surgical procedure to release the plantar fasciitis. There is a small incision and the recovery is around 3-4 weeks. The good news is that I rarely need to perform this surgery with such a high success rate from conservative care.
One of the predictors of alleviating plantar fasciitis pain is how long the heel pain has been active. After the connective tissue is damaged for an extended period it will change like a bruise of a banana. It may not return to normal tissue and this severely limits overall success.
If you have the “Tough Guy Syndrome” and put up with chronic inflammation you may have a tougher time completely resolving plantar fasciitis. If walking funny when you get out of bed, having your kids or grandkids outrun you, or giving up an active lifestyle is OK with you…it is OK with us.
Plantar fasciitis is one of those problems that looks like the doctor solves the problem but it really is the patient doing all the work. Just like weight loss, glycemic control, and a healthy lifestyle, your physician is just an observer and guide. The success, or not, is largely dependent on the person doing the day-to-day work. I will be happy to share in your success when you run pain-free, hike your favorite trails, win a pickleball championship, or play with the kids. The goal is to have you forget about the heel pain.
I will be there if you have a return and we can review all the things you did that worked before. Remember- chances are good that you will see me again if you discontinue the orthotic therapy and stretching regime.
We Want You to Have a Good Morning Again!
Whatever you do, don’t simply accept heel pain as a part of life. If you suffer from heel pain and plantar fasciitis, call my Indianapolis office at (317) 545-0505 or contact my office online to request an appointment.
I am here with real solutions that not only address your symptoms but the fundamental causes of your plantar fasciitis — and other forms of heel pain, too!