Bottom of the heel pain is a very common complaint. This pain is usually caused by a condition called plantar fasciitis. The plantar fascia is a very strong band of tissue that is located on the bottom of your foot. It extends from the ball of the foot to where it inserts on the bottom of your heel bone.
Symptoms of Plantar Fasciitis
The symptoms frequently are most severe first thing in the morning. You may find that it hurts a lot to put weight on the bottom of the foot but gradually after several minutes the pain seems to dissipate and later in the day there may only be a tightness type of feeling on the bottom of your heel. Pain can be very intense, and it is located directly on the bottom of the heel and oftentimes, towards the inner side of the heel.
What causes Plantar Fasciitis?
Biomechanics
It is thought biomechanics play a major role in causing plantar fasciitis pain. People that have a high arch may be more likely to have this condition and others with flat feet may also be more prone to getting plantar fasciitis.
Trauma
There may be some cases where excessive trauma such as jumping from a height could start plantar fasciitis as there may be microscopic tears where the fascia attaches to the heel. This could also be the case if one leg is favored and you’re putting more weight on the opposite foot.
Tight calf muscles
Tightness of the Achilles tendon or calf muscles will not allow for the ankle to move upwards and therefore creates more stress on the fascia while walking or running.
Overuse
This can occur from doing too much too soon especially when there are long periods of activity on your feet with very few periods of time to rest. Doing too much too soon can place stress on the plantar fascia, and this can make the pain worse.
How is Plantar Fasciitis Diagnosed?
Clinical Presentation
The doctor will note that the pain is located on the bottom of your heel at the location where the fascia inserts onto the heel bone.
X-rays
Doctors may use X-rays to rule out other conditions, such as potential stress fractures, or to observe a heel spur.
Diagnostic Ultrasound
Diagnostic Ultrasound is good to evaluate the severity of your plantar fascial condition. An abnormal fascia will appear thicker and have a different coloration than a normal plantar fascia and this has been well documented so that the doctor can rate your plantar fasciitis from a mild condition to a more severe condition. The severity of your plantar fascia on ultrasound corresponds very closely to the severity of your symptoms.
MRI / Magnetic Resonance Imaging
An MRI can be used to rule out a plantar fascial tear or stress fracture.
Treatments for you to consider
In the early stages of plantar fasciitis, you may want to try one of the following:
Heel Pads
Heel pads may help cushion the bottom of the heel and reduce the pain but only in early stages.
Stretching
If you have tight calf muscles or tight Achilles tendon, stretching of the calf muscles may be useful along with attempts to stretch the plantar fascia by pulling your toes upwards.
Over the counter arch supports
Over-the-counter arch supports may help support the plantar fascia as it pulls from your heel.
Supportive shoes
If your shoes are worn down, you may want to consider more supportive shoes that are frequently referred to have more motion control. For women, it may be important to avoid high heel shoes.
Icing
When using this option, it is suggested that you ice for 20 minutes.
What Treatments Your Doctor Would Recommend
Orthotics
A custom-made orthotics supports the arch therefore reducing the pulling of fascia from your heel. As we get older, the fascia becomes less flexible, and many believe this lack of flexibility is the main cause of plantar fasciitis. There is more tension of the fascia trying to pull from the heel because it is not as flexible as it used to be.
Cortisone injection
Doctors may suggest cortisone injections, which are often helpful, but they may only provide temporary relief and act as a Band-Aid.
Stretching and Night Splints
Patients can attempt both of these treatment options, which may offer relief for some but have been shown to cause more pain for others. Use common sense if you have tried this and find very little benefit or sensing there is more pain.
The Two New Treatments
Advanced treatments that you may not have heard of but may likely get to the root cause of your Plantar Fasciitis
The word plantar fasciitis describes pain at the bottom of the foot. However, in recent years, a study challenged the idea that the fascia is inflamed. During surgical procedures for plantar fasciitis, surgeons submitted specimens to evaluate the fascia. Only one of the fifty specimens showed inflammation of the tissue. The other forty-nine specimens showed the fascia was breaking down and were not viable tissue. Therefore, doctors refer to this condition as plantar fasciosis. This new concept supports the idea that the fascia is not very vascular, and because it constantly pulls from the heel, micro tears may occur in the fascia that never fully heal. The same pulling from the plantar fascia on the heel is thought to create heel spurs, but research has proven that bone spurs do not cause pain.
The following are more advanced ways in treating plantar fasciitis:
- The use of human cellular tissue products – A commonly used term for this is stem cell treatment. This concept involves injecting human cellular tissue products into the damaged area of the plantar fascia. We are now able to help repair the micro tearing by using this process. A healthcare provider performs this procedure in a clinical setting, and patients recover by ambulating in a CAM walker for 1 to 2 weeks before returning to regular activities. This is a highly successful option.
- Shockwave treatment – often referred to as Extracorporeal Shock Wave Therapy (ESWT) and this is another highly successful option. This treatment uses high-energy soundwaves focused on the area of pain. Traumatizing the plantar fascial tissues helps repair the fascia damage by stimulating the body’s own reparative processes. This usually involves a series of three treatments. It also done in a clinical setting.
It is important to note that these two treatments have significantly lowered the number of patients that have to go to surgical treatment.
- Surgery – Surgery is the last resort. Most foot and ankle surgeons use a low invasive technique. A The scope visualizes the plantar fascia, and the surgeon releases the fascia by cutting a portion of it, allowing it to stretch. Doctors allow most patients to ambulate in a CAM walker for 3 to 4 weeks, and this treatment has a high success rate.
If you think you have plantar fasciitis, it is important to seek professional attention sooner than later. If you are following the recommendations for self-treatment in this blog and you are sensing very little progress, it may be time to seek the medical advice of a podiatrist.