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My Heel Is Killing Me... I Can't Walk... What Is It?

Dec 25, 2007
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. For more info: Arthritis Treatment
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