When we break down the terms plantar and fasciitis we come up with this: Plantar = Bottom, Fascia = Connective Tissue and Itis = Inflammation. So, quite simply, you have inflammation of connective tissue on the bottom of your foot. The key to effective treatment is to REDUCE your INFLAMMATION. Once you are able to decrease the amount of inflammation in your heel, you will also reduce your pain. Your heel pain is being caused by inflammation of the large plantar ligament (fascia) of your foot and by tight calf muscles. This ligament is subordinated to “overuse” which causes the pain. When these inflamed tissues cool at night, or with rest during the day, they become tight. Any weight bearing activity then causes an increased stretch, which results in pain. Bone spurs, if present, are not usually the cause of the pain. If you are experiencing pain in your heel, especially with your first step in the morning or immediately after rest, and that pain eases up after a few steps, the following regimen should be followed:
- ICE the sore area at least 3 times daily, either with a frozen water bottle or ice massage for 10 to 15 minutes.
- STRETCH the arch ligament and calf muscles. This should be accomplished with the use of a night splint. You should use a night splint for 30 to 45 minutes every night to stretch out your calf muscle, achilles tendon, and plantar fascia. They are all connected and are contributing to your pain. The great thing about the night splint is that you can put it on and forget about it, you do not have to be in constant “work out mode” to get the stretch you need.It may also be helpful to keep a stretch band handy when resting for long periods of time, you can “sling” it around the ball of your foot for a good 30-second stretch. The “towel stretch” may lessen the severity of the pain you get during that first step after resting.
- ANTI-INFLAMMATORY medication may be taken if prescribed. Take as directed and discontinue if stomach pain occurs. Over the counter medications like Aleve may help as well.
- NO BAREFOOT WALKING! This includes just socks, lightweight slippers or sandals.
- RUNNING OR CROSS TRAINER SHOES should be worn exclusively. This needs to be a brand, sturdy motion-control shoe. Recommended brands include Orthofeet, Orthaheel, SPIRA, New Balance, Avia, Asics, Nike, Brooks, and Saucony. Rigid heel counters, rigid shank, external heel stabilizers, and dual density midsoles are important features.
- IMPROVED ARCH SUPPORTS are required for improvement of heel pain. These supports will stabilize your foot and allow your feet to function properly, relieving the excess stress typically put on your arch and heel. Custom orthotics are recommended. You will have to see a podiatrist to have those made for you. However, you can find a good pair of over the counter orthotics that may help, too. We recommend “Powerstep” inserts. They fit most average foot types and will provide you with the support you need for about 6 months at a time.
- WEIGHT LOSS if needed. This is often a common denominator with heel pain.
- Additionally, a product like Biofreeze will offer temporary relief and can be used as often as needed.
You have to follow this treatment plan “Like a Religion”. If you do not, you will not get the pain relief you are looking for, and you may very well wind up back at square one. A great number of our patients get better using this treatment plan and DO NOT end up getting injection therapy or find themselves in the operating room. This condition is very treatable if you do your part. If your heel pain persists then you are a candidate for corticosteroid injections and physical therapy. If there is no, or minimal relief AFTER all of the above things, including injection therapy have been tried, it may be time for surgery.