Plantar Fascitis

Heel Pain

 

What causes heel pain?

Plantar Fasciitis  Plantar Fascia is a very strong fibrous band (fascia) reaching along the bottom of the foot. Starting at the bottom of the heel and fanning to the toes. Insertion point into the heel bone is smaller and weaker than the other end which inserts into all five toes. Plantar Fasciitis, heel spur syndrome is caused by a mechanical imbalance in the patient’s feet which can be excessive pronation or abnormal supination. Falling arches (overpronation) causes the foot to elongate requiring plantar fascia to stretch. Because plantar fascia does not stretch, it pulls very hard at the insertion point in the heel bone causing small tears, swelling and pain.

Heel spurs may develop as plantar fascia continues to pull away at the heel bone. Radiograph may reveal the presence of a spur. More often than not the amount of pain is much greater than the heel spur observed, but sometimes, even a large heel spur may not cause any pain. As a rule, the first few steps in the morning are the most painful. Many times the pain comes back after each episode of rest, sitting or driving. This pain may become persistent, even hurt at rest if left untreated.

Achilles tendinitis hurts in the back of the heel. Because the process is similar to plantar fasciitis, the pain may be more pronounced in the morning, increasing as the day progresses. In many cases, some patients present with Achilles tendinitis and plantar fasciitis at the same time.

 

Will it heal on its own?

In some patients the pain goes away for months at a time, but when the pain returns, it is much worse. Heel pain tends to increase with each such episode. It may become chronic if left untreated, making it more difficult to treat. Carefully designed and crafted custom made orthotics are very important for long term relief of heel pain.

 

How is heel pain treated?

Before starting any treatment, a proper assessment and biomechanical examination must be completed. This will also help decide which treatment or combination of treatments is best for each individual patient. Common remedies like icing the painful area may provide temporary relief. Low-Dye taping of the sore foot tends to prove itself useful in the initial stages of treatment.

 

Treatment Options

Custom Made Orthotics: Custom made orthotics are very effective in treating heel pain. These devices are inserted into shoes to keep the foot positioned properly with adequate support.

These are the main types of ORTHOTICS:

1. OVER-THE-COUNTER TYPES, available in drugstores, can ease MINOR heel and arch pain and somewhat offer extra support in a running or walking shoe. Many are too flexible to offer much more than padding, but they can be a good place to start. They cost approximately $20.

2. PRE-FABRICATED DEVICES are made from semi-flexible materials. They are recommended for painful, persistent calluses and neuromas (nerve inflammation in the ball of the foot). They are available at a chiropodist’s or podiatrist’s office. Some chiropractors can also dispense them for minor biomechanical problems. They cost approximately $100.

3. PRESCRIPTION ORTHOTICS, custom-molded orthotics, made to fit the foot precisely from a cast taken of the feet and after a thorough biomechanical examination. They are available ONLY at a foot specialist’s office. They range in price from $400 to $600 and the cost is covered by most extended health insurance plans and includes adjustments if needed and a warranty. These orthoses can be functional or accommodative:

Rigid Orthotics – These functional custom orthotics are precisely crafted to control the motion of specific foot joints which may be directly impacting the alignment of lower extremities thus stabilizing the entire gait cycle. In many cases, painful knees are positively affected as well as hips and lower back. Walking shoes or dress shoes usually accommodate them well. Hard plastics or even carbon fiber may be used to fabricate such devices. They may be recommended for heel spurs, plantar fasciitis, etc.

Semi-Rigid Orthotics – These functional custom made orthotics are fabricated with different layers of soft materials, then strengthened with stiffer materials. They are constructed in a way that stabilize the feet while playing sports or simply walking. These orthotics work well to lessen foot, ankle, knee, hip or back pain in athletes who are training. Also, they are frequently prescribed to treat children with flat feet, in-toeing or out-toeing disorders.

Soft or Accommodative Orthotics – These soft or accommodative custom made orthotics are best suited for patients who have diabetes, ulcers, arthritis, or foot deformities. They are constructed in a way that absorb shock, promote stable ambulation and significantly reduce the weight that is bearing on uncomfortable and sore areas of the feet. They are fabricated with soft and supple materials that provide cushioning for the sole of the feet, from heel to toe.


Cortisone Injections: Cortisone injections are very helpful in temporarily relieving or managing heel pain caused by chronic plantar fasciitis. It is important to exhaust all other non-invasive treatment option before considering cortisone injections.

Cortisone is a natural hormone produced by the adrenal gland when a person feels stressed. A synthetic version of this matter can be injected directly into the plantar fascia or the side of the heel. This will bring down the inflammation, which may provide temporary pain relief. The pain will begin to subside within a few days and may last up to a few weeks or sometimes even a few months.


Radial Soundwave Therapy: If you suffer from heel pain in Hamilton, Ancaster or Dundas, you may want to try Radial Soundwave Therapy. Heel spur syndrome, Plantar Fasciitis and Achilles tendinitis all are painful conditions affecting the person’s heel that may be effectively treated with RST in our clinic. RST therapy does not require anesthetic or time off your feet. It is a non-invasive, non-surgical treatment that unifies electronics and air pressure to create high intensity sound waves. These sound waves penetrate the heel encouraging a healing response and releasing endorphins (our body’s own natural pain killers).

This treatment method is recommended for people who still experience pain after trying other more conventional treatment methods such as Lo-Dye Taping, custom made orthotics or/and cortisone injections. It is important to first resolve any underlying biomechanical problems to attain the best results with RST.


Icing: In combination with resting, stretching and custom made orthotics, icing the sore heel and/or arch can be very beneficial in helping you recover. Applying ice to the sore area decreases inflammation, relieves pain and is a very low-cost treatment option. There are many ways you can ice your painful heel(s). Try them all and see which you prefer.

1. ICE CUBES: Put a few ice cubes in a towel or a plastic bag, and apply directly to the painful heel and/or arch.

2. FROZEN VEGETABLES: Using a bag of frozen vegetables like corn or peas is a great icing option, as they conform to the curve of the foot nicely. The bag can be applied directly to the painful heel and/or arch. Wrap it in a thin towel first if you find it too cold.

3. ICE-PACKS: You can purchase ice packs at any store or pharmacy. The gel or malleable ice packs work best for the feet. Wrap the ice pack in a thin towel, and apply it to the sore heel and/or arch.

4. PAPER OR STRYROFOAM CUPS: Fill some inexpensive paper or Styrofoam cups with water and freeze them. Once frozen, tear off the paper cup so that you have only a chunk of ice. If you’d rather have a barrier between the ice and your fingers, tear off the top half of the cup only to create a “handle” to hold on to. Hold it from the bottom and apply to the sore area. The ice’s cylindrical shape makes it easier to ice the arch of the foot and the circular shape is perfect for massaging the painful heel and/or arch.

5. WATER BOTTLE (plastic, not glass): Freeze a few plastic water bottles. Put the frozen water bottle down horizontally on a towel and gently roll the sore foot over the bottle. This option combines icing with massage. The ice will reduce the inflammation while the rolling massage will sooth the pain.

It is better to ice at the end of the day because your feet need a chance to warm up a little after you get out of bed. Remember to always keep some kind of barrier between the ice and your skin when icing, such as a thin towel or paper towel. Do not ice more than 20 minutes at a time and leave at least one hour in between icing sessions.


Compression sleeves: Compression sleeves are a type of tightly fitting, toeless “socks” that are intended to provide added compression along the plantar fascia. It keeps the foot stable and the plantar fascia slightly stretched, thus reducing the pain. Compression sleeves are another inexpensive treatment option and can comfortably be worn under socks, in shoes or even while your sleep.

For those who sit for extended periods of time, compression sleeves are a good treatment-aid in combination with custom made orthotics as they can reduce the pain next time you stand on your feet. They also have the same effect when used as a night splint.


Strassburg Sock: The Strassburg Sock is a rather simple device used to stretch the dorsal structures of the foot and lower leg at night while you sleep. It is a kneehigh stocking with an adjustable strap connecting the toe part of the sock to the top of the sock. This keeps the foot in a slightly dorsiflexed position throughout the night.


Stretches: There are several stretching techniques suggested for heel pain by various authors.

1. While sitting down on the floor and knees fully extended (straight), a towel or a wide tape is looped around the forefoot, and the patient uses the arms and pulls it towards the upper body.

2. While standing on a step on the “balls” of their feet with the heels overhanging the step, the patient lowers or “hangs” her/his heels down towards the floor without touching the floor.

3. The patient stands facing a wall, with both hands on the wall. The leg that is being stretched is placed further back and the other one is placed closer to the wall. On the stretching leg push the heel down and attempt to lift the toes at the same time. Each stretch should last approximately 30 seconds per leg. Each leg should receive 10 stretches per day.


Low-Dye Taping: Low-Dye Taping is often a short-term treatment for heel pain. It is designed to offload plantar fascia. The tape may stay on the patient’s foot for about a week up to 10 days. Many times, patients like this treatment and come back for re-taping. Very often this treatment provides patients with almost immediate heel pain reduction. At Ancaster Foot Clinic, we use 1” zinc oxide “rigid” tape such as Leukotape. After taping, the foot may feel somewhat constricted for a short while. It gets more comfortable as the time progresses. 

 

Robert Nekrasas D.Ch. and “Ancaster Foot Clinic & Orthotic Centre” expressly disclaim all warranties and responsibilities of any kind, whether directly or indirectly expressed, for the accuracy or reliability of all content and information contained in this website.

This website is strictly for educational and/or general information purposes only. Reliance upon or use of any information found on this website is at your own will and risk. It is not intended for diagnosing or treatment of any of the foot conditions described or illustrated on this website. Any illness or pain should be assessed by a dully certified health care provider such as Chiropodist, Podiatrist, Medical Doctor, etc.