Sunday, March 11, 2007
Heel pain - Plantar Fasciitis
My right inner heel is killing me. It started a few weeks ago after playing tennis and each time I play I wake up limping the next morning. I can press on one area of my heel (calcaneous) and "ouch" that's where it is. I have the most common cause of heel pain in adults....plantar fasciitis.
Plantar fasciitis occurs more frequently in women and is often seen in runners and dancers who use repetitive, flexion of the ankle and foot bones (metatarsophalangeal joints). It can be caused by improper footwear, change in intensity of physical activity or a change in the walking surface. Other causes are reduced flexibility, tight achilles tendon, discrepancy in leg length or sudden weight gain such as pregnancy. I think I know where mine came from...new tennis shoes and increased activity.
The plantar fascia is a band of tissue that fans out across the sole of the foot from the heel to the bones of the foot. As the heel strikes, the leg bone (tibia) rotates internally and the foot turns in (pronates) which stretches the fascia as the foot flattens. Because the plantar fascia has no elastic properties, this repetitive stretching results in microtears at the heal. These microtears lead to collagen degeneration at the calcaneous (heel bone) and this causes the heel pain. This pain usually comes on insidiously. Most patients don't remember any trauma and they describe the pain as a deep ache that is worse in the morning and lessens after about 20 minutes of walking.
Here is the good news. Plantar fasciitis is usually self-limited. Here is the bad news. It can take as much as 6 to 18 months! The longer the symptoms exist, the healing takes longer so it is important to start treatment. Here is what a person with plantar fasciitis should do:
1. Correct any training errors. Change high-impact activities to low impact such as biking or swimming. Change shoes if they are a factor.
2. Increase the flexibility of the calf muscle and achilles tendon with stretching. One way to stretch the plantar fascia is to fill a plastic bottle with ice cold water and roll the foot arch back and forth over it.
3. Ice the foot at least once daily. This can be done as ice pack (crushed ice in a plastic bag) held in place for 15 minutes or an ice bath. Soak on the heel only and keep those toes out of the ice water.
4. Strengthen the foot muscles. In one study 35% of patients cited strengthening programs as the most helpful. Strengthen by placing a foot flat on the end of a towel and keep the heel on the floor. Then pull the towel toward the body by curling the toes. One can also pick up marbles with the toes and place them in a cup, keeping the heel on the ground.
5. NSAIDs. This is Advil, Motrin or Aleeve. These non-steroidal, anti-inflammatory drugs are effective in treating pain and reducing inflammation. Prolonged NSAIDs can cause GI bleeding or kidney problems in certain patients so check with your own doctor if you take them for extended periods of time.
6. Orthotics and night splints. Over the counter arch supports can help as can a heel pad or heel cup. Custom orthoses - made from an impression of the patient's foot-are expensive and designed to control biomechanical factors. Night splints keep the ankle in a flexed position and allow stretching of the calf and the plantar fascia while the patient sleeps.
I think if I follow the doctors advise and spend a little time paying attention to and rehabing my heel pain, I can be pain free soon. Gotta go get my ice pack ready.
Posted by Toni Brayer, MD at 9:54 PM