Have Pain in Your Heel and Arch of Your Foot?
If you are experiencing heel pain, pain in your arch, or both, there is a good chance that you have plantar fasciitis. But don’t panic. With proper care from a heel pain doctor you will be headed in the right direction. Plantar fasciitis, sometimes called runner’s heel, is a common foot condition that while painful, is completely treatable. If you’re a runner, you’re probably wondering how long it will take to heal. The answer is different for each person, but the sooner you see a doctor for heel pain the faster you will be on the road to recovery.
What is Plantar Fasciitis?
Plantar Fasciitis is inflammation of a long band of tissue called fascia that runs from your ankle, over your arches, and to your toes. The condition is characterized by heel pain, arch pain, and swelling.
Heel pain is often the first sign of plantar fasciitis. Understanding what plantar fasciitis is and how it can be treated is important for a full recovery. The first step in determining whether you have this condition is visiting a foot specialist or podiatrist that treats it. Dr. Dennis is an experienced doctor for heel pain, treating patients in the Houston area for over 30 years.
Plantar Fasciitis Symptoms
- Heel Pain
- Swelling
- Arch Pain
- Inflammation
- Reduced Mobility
- Heel Spurs
To understand what plantar fasciitis is and what causes it, first you need to know the biology behind the fascia and the role it plays in your ability to walk, run, and stand. Plantar fasciitis is inflammation of a long band of tissue called fascia, that runs from your ankle, over your arches, and to your toes. The condition is characterized by heel pain, arch pain, and swelling. Heel pain is often the first sign of plantar fasciitis. Understanding what plantar fasciitis is and how it can be treated is important for a full recovery.
The plantar fascia is a large ligament on the bottom of your foot which helps to support the arch. It starts under the heel, and where it connects to the heel bone is about the size of your index finger. It extends along the entire bottom of the foot and splits into five slips which insert into each of the toes. It narrows down and is very small at its attachment under the heel.
This attachment to the heel is the weak link. Anything that increases pressure through the arch, causes the fascia to pull on its attachment and literally rips it loose from the bone. This causes inflammation and swelling, hence pain. Over a period of time the fascia will try to strengthen itself by laying down bone around the origin and this forms the heel spur often seen on x-ray.
What Can Cause a Re-Lapse or Worsening of the Condition?
Anything that puts more pressure on the plantar fascia may cause inflammation. This may be as simple as a 5 pound weight gain, change in activities, worn-out shoes, walking barefoot, hard floors at home, or anything else that puts pressure through the arch.
Will Plantar Fasciitis Go Away On Its Own or Do I Need a Doctor?
Chances are you need to see a doctor for heel pain or arch pain, because if it plantar fasciitis is the condition causing your heels or soles to hurt, it needs to be treated by an experienced podiatrist.
During the day, you are constantly traumatizing the arch, but as the muscles contract during walking they actually serve to massage fluid up out of the heel back into the circulation. When you sit down (or particularly when we go to bed at night) gravity begins to pull fluid down into the heel and the heel begins to swell. You will not see this swelling on the surface because the skin is so thick.
However, when you stand up after prolonged sitting or sleeping the force of your body weight on the heel pushes that fluid out on nerves and causes pain. You tiptoe in to the bathroom and then the foot begins to “warm up” and here we go again!
The arch never has a chance to get better because you are constantly on it. If you could simply rest for 2-3 weeks, the pain would probably resolve. However, with today’s active lifestyle, that is next to impossible.
Plantar Fasciitis Treatment Options
The first step in treating plantar fasciitis is arch support to rest the fascia connection on the heel. We have to support the arch, get the inflammation out from under the heel, and stretch the Achilles’ tendon.
Sounds simple — it may take months to resolve. However, the goal is to get 50% improvement within the next four to six weeks, and then there will be light at the end of tunnel.
Our steps in treatment will include:
- No walking barefoot. Put some house shoes or flip-flops by the side of the bed – the more cushion and arch support, the better.
- Arch support is crucial for the healing process. Unless your arches are protected and rested, the heel and arch pain cycle will continue.
- Stretch the Achilles – this may be the most important step in the treatment. Remembering to stretch is a nuisance but this is easy to do.
- Massage the Arch and Sole – This really helps get the inflammation out at the end of the day. I recommend getting a tennis ball and putting it on the floor someplace where you sit – for most of us that is at the computer. While sitting use the tennis ball to massage the arch. When you do find the point of maximum tenderness, really focus on that area to massage. This should be slightly uncomfortable.
- Ice Arch and Heel – There are many ways to ice the arch and heel. Use your favorite.
Assessing Plantar Fasciitis Severity
Normally, we begin with the previous simple treatments described above for 3-4 weeks. When you come back to the office, we will ask you, “are you 10%, 30%, 50%, 75% better?”. Your response will help direct subsequent treatment.
If you are at least 50% better, we normally need to simply stay the course, and the pain should resolve. If you are less than 50% better, we will include more aggressive treatment options to stop the foot pain caused by plantar fasciitis.
More Aggressive Treatment Options for Plantar Fasciitis
- Cortisone injections – Cortisone is a naturally occurring substance your body makes. Its job is to stop inflammation. We can give you cortisone pills to help supplement this, but in order to give you enough by mouth to get all the way down to your feet, there are significant side effects. Therefore, we put the heel to sleep with local anesthetic and then inject a small amount of Cortisone at the point of inflammation – this breaks the pain cycle allowing your body to get the upper hand and begin to heal. Cortisone lasts for 7-10 days, and during this time, you should have significant improvement. As the Cortisone wears off the pain may return – this is to be expected, so don’t be disappointed. A 2nd injection should resolve the problem. If needed, we may use a total of 3 injections. If 3 does not work, 10 will not work, that is why we limit ourselves to three.
- Anti-inflammatory medications – Although they have gotten some very bad press lately, we may use a prescription strength anti-inflammatory and continue home treatment, and simply give it a little more time. The most common side effect of these medicines is an upset stomach – be sure to stop taking the medicine immediately and let us know if you have any side effects.
- Mechanical Control – If the underlying cause of the pain is the arch flattening out, then some type of support is often critical. To provide immediate relief, and to help guide future treatment, we may either tape you foot (& possibly teach you how to tape it) or construct a semi-custom temporary orthotic ($35 fee not covered by insurance). If these measures provide improvement, but not resolution of pain, we will then follow up with a custom functional orthotic (described in more detail below).
- Night Splint – As noted above, stretching is critical for effectively treating heel pain. If you think about it, when you sleep at night your toes point down all night long and this causes the Achilles tendon and plantar fascia to tighten. A night splint simply holds the foot at a 90° angle as we sleep and helps to stretch out the Achilles tendon. Very effective treatment – not a lot of fun! ($75 — not covered by insurance).
- Cast – The foot cannot heal because you are on it all day. A cast can immobilize the foot allowing healing to occur, and allow you to at least function.
- Rest – For most athletes, rest is a “4 letter word”! But sometimes, the most effective treatment is to stop the stress that is causing the injury. Rest does not have to mean no exercise – it simply means cross training to get the stress off the heel.
- Physical Therapy – We may consider a course of physical therapy. This is a wonderful treatment, but very time consuming – you would need to plan ~2 hours out of your day; 3 days each week for 3-4 weeks.
Foot Surgery for Plantar Fasciitis
Unfortunately sometimes conventional treatment is not successful in managing foot and heel pain for patients with plantar fasciitis, and surgical options should be considered. We have two minimally invasive procedures to choose from. Each patient’s unique condition and circumstances determine which one is recommended.
- Extra Corporeal Shock Wave Treatment – ECSWT – This is a relatively new treatment similar to the treatment for kidney stones. It is performed in an outpatient surgical center under sedation. Pulses of ultrasound are passed through the foot causing a profound inflammation which 80% of the time leads to healing. Very little time off work is required – the procedure may be done on Friday with return to work on Monday.
- Endoscopic Plantar Fasciotomy – EPF – A surgical procedure in which a small camera is inserted into the bottom of the heel and ~70% of the ligament is cut. After the surgery, as you bear weight, the ligament stretches and heals in a lengthened position relieving the pull on the bottom of the heel.
