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Find out what's making your heel hurt, and what to do about it

By Cary Groner

You may know the feeling: you get up in the morning, slip out of bed and step toward the dresser to pick out something to wear. But when your foot hits the floor — ouch! You feel like you've stepped on a knife. What gives?

There's a good chance you may have plantar fasciitis, a common heel pain condition that affects two million Americans annually. It's important to see your doctor to confirm the diagnosis, however, because other conditions can cause similar symptoms.

Ruling Out Other Problems

Numbness, burning pain and tingling, for example, are more likely associated with nerve problems such as tarsal tunnel syndrome, in which an important nerve to the foot — the tibial nerve — is injured by pressure from a ligament on the inner part of the ankle. Other common conditions that cause heel pain include arthritis and fractures of the heelbone. Once your doctor has ruled out such problems, he or she will ask questions and do a physical exam to confirm that you have fasciitis. Pain on the first few steps in the morning, as described above, is a classic sign.

What Is Plantar Fasciitis?

The plantar fascia is a wide band of tissue that runs from the bottom front of the calcaneus (heelbone) along the bottom of the foot to the toes. According to the National Institutes of Health, fasciitis occurs when this tissue is overstretched or overused, and may be associated with arch problems, weight gain, overtraining, a tight Achilles tendon and improper or unsupportive footwear.

Some forms of fasciitis are considered an inflammatory condition and may be brought on by a sudden change in exercise habits. Even well-conditioned athletes have the problem; if someone is used to running three miles four times a week and then runs a marathon, she could develop fasciitis.

In other cases, onset is slower, and symptoms may persist over months or even years. Some clinicians now call this condition by another name — fasciosis — because research suggests that it's associated with long-term degenerative changes in the fascia rather than inflammation. Those changes may be brought on by a lower exposure to the same kinds of stresses that lead to acute-onset fasciitis, though, which means that treatments may be similar.

What Do I Do Now?

Regardless of the cause, most clinicians start by treating fasciitis with RICE, or Rest, Ice, Compression and Elevation — a common strategy for overuse injuries. Your doctor may also suggest that you take anti-inflammatory drugs like ibuprofen and limit your activities until the pain decreases. Many cases of fasciitis resolve on their own with these minimal treatments.

Physicians may also suggest a pair of prefabricated shoe inserts that provide arch support and cushioning. And although studies indicate that prefab supports work for fasciitis as well as more expensive custom orthoses do, some patients try the latter if the prefabs don't bring the desired result within a few weeks.

People with relatively normal feet may need to wear the inserts for only a few weeks, while concurrently doing exercises to strengthen the arch and muscles of the feet, calf and thigh so they no longer need the extra support. Those whose feet have other problems — for example, very high arches or biomechanical abnormalities — may need to wear inserts or orthoses for the rest of their lives in order to keep the fasciitis from recurring.

Stretching Exercises for Plantar Fasciitis

Physicians and physical therapists have developed several techniques to help stretch the plantar fascia gently so it doesn't get so overstressed. All these techniques are based on bringing the foot and toes upward, toward the knee — or dorsiflexing them, as clinicians put it. Here are three popular approaches:

• Seated foot stretch. First thing in the morning, sit on the edge of the bed and cross the affected foot over the opposite thigh, so you can reach the foot easily. Dorsiflex the foot, pull the toes upward and hold for 30 seconds to a minute, then repeat.

• Standing calf stretch. Stand near a wall, then step back with one leg and gently press the heel toward the floor. This primarily stretches the Achilles tendon, which, if tight, can aggravate fasciitis. The position also provides a moderate stretch for the plantar fascia. Hold it for at least a count of 30, then reverse feet. To address tightness in the plantar fascia more fully, place a rolled-up towel under the toes while doing this stretch.

• Standing calf stretch with toe raise. Assume the same position as in the standing calf stretch, then place the toes of the front foot upright against the wall while keeping the ball of the foot on the floor. In this way, both feet are getting a slightly different stretch at the same time.

Other Approaches

If these approaches don't help after six to eight weeks, clinicians may try more drastic measures, including immobilizing your foot with a walking cast or a night splint to keep the foot dorsiflexed and provide a gentle stretch. Studies suggest that these approaches are effective, but many people don't like them for the obvious reasons; night splints can make it hard to sleep, and a cast is...well...a cast.

Other therapeutic approaches include the following:

• Corticosteroid injection. Some clinicians find this treatment controversial except in severe cases because steroids may weaken tissue and increase the risk of injury later. For those whose pain is so severe they can barely walk, however, steroid injections can provide temporary relief while they pursue other therapies.

• Shock-wave therapy. This approach has shown promise in clinical trials, but it's expensive — often over $1500 for a treatment — and most private insurance companies won't pay for it. If you live in Canada, however, you may be in luck.

• Surgery. Clinicians agree that this is a last resort, but in cases that don't respond to anything else, a surgical release of tight gastrocnemius (calf) muscles, or of part of the plantar fascia itself just forward of the calcaneus, can be helpful.

The Bottom Line

The good news is that in most cases, fasciitis will resolve on its own in a few months. So break out the ice and the ibuprofen, stretch and strengthen, check out shoe inserts and give your feet a break until they're feeling better. They'll thank you for it.

Published February 23, 2012.

Cary Groner is a writer based in the San Francisco Bay Area. His recent novel, "Exiles," placed fourth on the Chicago Tribune's list of the best books of 2011.

See also:

• Common causes of knee pain
• Ease winter arthritis pain
• Common causes of back pain
  
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