Plantar Fasciitis
Heel pain is one of the more common diagnoses seen in a podiatrist's office. The most common condition that causes heel pain is plantar fasciitis. Let's take a look at plantar fasciitis including what causes it and how to treat it.
The terms plantar fasciitis and heel spur are synonymous. Heel spur is actually an older reference to this condition. We used to believe that the pain experienced in this condition was due to a sharp spur on the bottom of the heel. But over the past twenty years or so, we've begun to realize that the spur really doesn't cause any pain in this condition. Pain is due to a structure called the plantar fascia.
The term plantar fasciitis is a tongue twister, but the term more accurately describes this condition. Plantar is a geographic reference referring to the bottom of the foot. We've all heard of a plantar wart? That simply means that the wart is on the bottom of the foot. So in this case, we're dealing with a structure that's located on the bottom, or plantar surface of the foot. Fascia is a tough, inelastic structure that can be found at many different locations in the body. In this particular condition, the plantar fascia originates on the bottom of the heel and extends to the toes. You can actually feel the plantar fascia on the bottom of the foot in the middle of the arch. And the suffix, itis? Itis simply means that something is inflamed. Put all the words together; plantar, fascia, itis, and you have it -plantar fasciitis.
Call it a heel spur or call it plantar fasciitis, the first thing to realize is that it's a soft tissue condition and not a bone condition. The spur doesn't hurt. Pain comes from the plantar fascia being put under load as you stand. The fascia pulls so hard that it actually is trying to pull off of the bone.
The second important consideration in plantar fasciitis is the calf. Think of the plantar fascia as a continuation of the calf and Achilles tendon. The calf, Achilles tendon and plantar fascia actually make up one structure I call the CT Band (calf to toes band). The tighter the CT Band, the greater the problem with plantar fasciitis.
Patients who suffer from plantar fasciitis describe classic symptoms that include pain when first standing. Getting out of bed in the morning results in sharp, tearing pain in the plantar heel. The pain subsides over several minutes. Sit again, try to stand, and you'll experience more sharp pain. As the day progresses, the plantar heel aches the more that you stand. The pain is always relieved by rest.
So what can help relieve plantar fasciitis? Think cowboy boots. Cowboy boots are an old folk remedy for plantar fasciitis, and you know what? They worked. The reason they worked was due to the heel lift that they provided. By elevating the heel, you can weaken the CT Band. Weaken the CT Band and you allow the inflamed fascia to heal.
For many dancers, shoes and the height of the heel can be a challenge. Low heeled dance flats make the calf tighter and subsequently make the CT Band tighter. Remember, a low heel will increase the symptoms of plantar fasciitis.
To treat plantar fasciitis start with some simple calf stretches. My favorites are to use a step or stretching block. Stretch six times daily for about a minute each time. Stand with the toes on the step and drop the heel off of the step. Hold that position. This is not a calf raise - that'd actually be a calf strengthening exercise. Simply drop the heel off of the step and hold that position. In addition to stretches, a simple heel lift can do wonders. Remember, heel lifts and heel cushions are two different things. We don't want cushion, we want lift. Think cowboy boots!
Dr. Oster is a board certified podiatrist and pedorthist. Dr. Oster practices in Granville, Ohio and is medical director of Myfootshop.com, an on-line resource for foot care information and products.