by Melissa Gaffney, DPM
It’s your first step after getting up out of bed and you have sharp pain in the bottom of your heel and you hobble to the bathroom. It lasts about 20-30 minutes then subsides. Sound familiar? If so this is a classic sign of plantar fasciitis. There are many causes of heel pain but heel pain when first getting up called post-static dyskinesia is strongly associated with plantar fasciitis. This has been one of the most common problems I have seen in my practice over the last 29 years. It is tempting to ignore a brief episode of pain but more than likely it will worsen. It may hurt with any weightbearing and eventually become debilitating.
If you nip it in the bud now before it progresses , you can save yourself a lot of grief which can include lost time from work.
This post addresses new onset heel pain so pain at bottom of heel for no more than 1 to 3 months. Chronic heel pain will be addressed separately..
First what is the plantar fascia? The plantar fascia is a thick tough band of connective tissue like a tendon (but is not a tendon because it does not attach muscle to bone ) that runs from the heel bone on the bottom of your foot to the forefoot near the ball and separates into 5 bands here near the ball of your foot.
(Clemente,Carmine . sole of right foot. illustration. 1987. Regional Atlas of the Human Body . )
The origin at the heel bone tends to be thinner fibrous tissue and more susceptible to collagen degeneration. . So, this is why most of the pain tends to be at the heel on the bottom of the foot. The plantar fascia does meld into fibers of the achilles tendon insertion and calcaneal periosteum. So sometimes there can be pain extending to the back of the heel and sides. The condition of plantar fasciitis is more the degeneration than inflammation and can be referred to as plantar fasciosis instead of plantar fasciitis.
INSIDE LOOK AT THE ANATOMY of YOUR HEEL and FOOT from the side:
https://commons.wikimedia.org/wiki/File:Pedheelpainsp1.jpg
The plantar fascia acts a suspensory type ligament as shown above and is the base of a triangle with the two upper arms of the triangle being the heel bone and the other bones in your feet and your feet as seen above. Also on the bottom/sole of the foot the plantar fascia origin is the tip of a triangle with the base of the insertion at the ball of the foot. The base here splits into 5 bands so the tension is spread out at the ball. So, this makes the plantar fascia subject to a lot of tissue strain and stress as you can imagine.
So most of the tension is at the thinner aspect at the origin of the heel and hence where the degeneration and pain occurs in certain conditions.
**What are those conditions and why does plantar fasciitis happen?
Generally speaking, this post concerns what I have seen to be the most common causes of plantar fasciitis which are overuse and under support. There many other conditions which cause heel pain including stress fracture of the heel, heel fat pad atrophy, bone tumor, infection, heel skin fissures, nerve entrapment, gout, Rheumatoid Arthritis. In fact one of my first patients had undiagnosed rheumatoid arthritis causing heel pain. I have seen every one of these conditions causing heel pain in practice. So, it is important to see your doctor.
Well I hate to say it, but excess body weight is a major culprit as well. This is particularly true if there is fast weight gain. I started getting plantar fasciitis when I was pregnant after gaining the first 10 pounds. It makes sense when you see it as a suspensory structure. So if you have extra weight and you like to go around in flip-flops or barefeet , that can be a recipe for foot pain.
Plantar fasciitis is primarily an overuse injury causing microtears ( collagen degeneration) at the insertion site at the heel bone/ calcaneus. The body starts to try to heal these microtears with scar tissue causing the plantar fascia to become thicker. This is when the pain becomes chronic and much more resistant to treatment. We podiatrists consider plantar fasciitis chronic when symptoms have been present for greater than 6 months. So this is why it is important to begin treatment quickly.
So anything resulting in overuse :
*Increase in activity such as a new job or exercise which would include type of surface that activity involves.
*Weight gain
*Biomechanics of the foot and type of shoegear or lack thereof
- What can I do for it?
STRETCHING:
If you just started getting morning heel pain, you have the best, most opportune time to resolve your pain. Before you get up out of bed in the morning, do plantar fascia stretches.
Here is another stretch that I like. Wearing shoes put ball of foot against wall with heel on floor and with knee straight bring body toward the wall while keeping same position of foot and knee straight. If there is too much of a pull or pain, then move body back off the wall.
One should feel a mild pulling or stretch but there should not be any pain in any stretching . If there is any pain back off from the wall or ease back from whatever type of stretch you are doing and stretch from the point that there is no pain.
Here is another great plantar fasica stretch on a step . This is a wonderful stretch for the achilles as well which needs to be stretched along with the plantar fascia because their calcaneal (heel bone) insertions blend together. If you want to strengthen your achilles/ gastrosoleal muscle group (calf muscle) rock up on to your tip-toes on the step. Be sure to be holding onto something. Rock up onto your tip toes for about one to two seconds, and then come back down with your heels below the step.
I would recommend this calf muscle strengthening part as prevention for age related Achilles issues that are so common. Again, remember do not stretch at the point where it is hurting back off and stretch at a point where it does not hurt.
Again I recommend doing any of these stretches for 10 – 20 repetitions, holding each stretch for about 10 seconds and doing the set once or twice a day.
Strengthening the muscles under the plantar fascia is also important to offload and support the plantar fascia as well. Toe crunches with a towel and rocking the foot to the outside and inside will accomplish this . Do this for about 5 -10 minutes twice a day .
SUPPORT:
Because the plantar fascia is a long suspensory ligament band, when it gets strained it needs support. So I always recommended to my plantar fasciitis patients never to ambulate in barefeet, stocking feet nor slippers even in the house. So find a slide on indoor sneaker and use it as a house shoe . Easy spirit slide on sneaker or new balance slide on sneakers are good examples as seen below. You want the shoe to have arch support and a good supportive sole.
I know that many people are ” barefeet people” and this was a challenge in my clinical practice. In this case I recommend Birkenstocks or imitation Birkenstocks which are plentiful nowadays. One could even use Crocs as a house shoe.
Outside the house, I recommend wearing a supportive cross trainer sneaker or sandal most of the time. Brands that are good include but are not limited to : Saucony, New Balance, Merrell ( my favorite), Brooks, Ascis, Vionic Hokas. Hiking shoes like Timberlands , Keens, or Columbia are good as well. Vionic dress shoes, Danskos , sometimes Clarks, and Naots dress shoes usually have good arch support as well. I will do another post in the future on proper shoe gear for foot health. Tevas, Birkenstocks, Chaco’s, Keens are good sandals. I understand that good shoes are expensive. You can find knock-offs that are decent with these different shoe brands that may work out to help you. But in the shoe world especially, you get what you pay for. So the knock-offs will wear out much more quickly. Unfortunately for happy feet expect to spend at least $70 for decent shoes. Considering the cost of doctor visits, procedures, x-rays, lost time from work, $70 – $120 for shoegear is very cost effective. Asics or Saucony’s are on sale frequently at various stores. So it is possible to find a good pair for $50 if you are a good shopper. There are shoe stores that have overstock or sell shoes without a box where you can get high value shoes at a discount. For instance, I bought a pair of Dansko’s for $50 which normally run $150 at Beaty’s Shoes in Johnson City, TN . I also bought a pair of Naots for $50 normally well over $100, at French’s shoe store in Turkey Creek, TN.
These 2 tools, if done for a couple of weeks, should resolve most NEW onset morning heel pain and perhaps some heel pain that has been present for a while and untreated.
Soon to come tips and tricks for more chronic heel pain as well as shoegear and over the counter orthotic recommendations.
THANKS for READING and I HOPE THIS HELPS YOU!
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