Family Health Magazine - ACTIVE LIVING
The base of your heel is hurting again. The stabbing pain comes when you take your first steps in the morning and sometimes after exercise. If this sounds familiar, you may have Plantar Fasciitis.
The plantar fascia is thick connective tissue that supports the arch of the foot. It begins at the bottom of the heel bone (calcaneus), and extends towards the toes. It works as a shock-absorbing strap helping to maintain the shape of the arch of the foot (see illustration).
To feel this structure, put your hand on the mid-sole of your foot. As you lift your toes up, you will feel a cord-like structure pop up in the arch of your foot. This is the plantar fascia.
When this tissue becomes inflamed, it is called plantar fasciitis. Usually, it appears where the plantar fascia attaches to the base of the heel bone. A sudden change in the amount or intensity of exercise, as when beginning an exercise program, can bring it on. However, even regular day-to-day physical activities and chores can trigger symptoms. Improper shoes and inflexibility in the calf muscle can also contribute.
Pain typically occurs after exercise and physical activity. As the condition worsens, it can appear during exercise. Weight bearing exercises, such as brisk walking, running, and golfing, usually make plantar fasciitis worse. Pain is usually relieved with resting and getting off the feet. However, the first few steps after getting up from sleep or having a meal are often painful. Direct pressure where the plantar fascia inserts at the heel, as with walking on a hard surface in bare feet, can also hurt. Plantar fasciitis usually affects the base of the heel, but the pain can move along the fascia into the arch.
Getting a foot up on plantar fasciitis
- When out for a walk, find a wall to lean against. Stand at arm’s length from the wall.
- Place the leg you are stretching about 12 to 18 inches behind you.
- Keep your toes pointed forward and slightly inward.
- Bend your arms and gradually lean towards the wall.
- Make sure your leg is straight and the heel of your back leg is pressed to the ground.
- Feel the stretch in the calf and heel of the back leg.
- Hold the position for 30 seconds and return to starting position.
- Repeat three times for each leg.
The following strategies, often in combination, can help manage the symptoms of plantar fasciitis.
- Change your activities. Avoid aggravating activities by cross training, or exercising in different ways. Non-weight bearing activities, including swimming, cycling, and using the elliptical trainer, will work best. Maintain strength training and continue your activities, as long as they do not make symptoms worse.
- Wear appropriate shoes. Be sure your footwear fits comfortably, absorbs shock, and has adequate arch support. Most runners should change their running shoes every 400 to 800 kilometres.
- Try anti-inflammatory medication and ice. You may be allergic or sensitive to anti-inflammatory medications. If not, try ibuprofen or a non-steroidal medication prescribed by your doctor for inflammation. Take the medication regularly for several weeks to reduce inflammation in the plantar fascia. Using ice before and/or after activity can help.
- Stretch the calf and Achilles tendon, and do exercises to strengthen the calf muscle. This type of home program is key to managing plantar fasciitis. You can start your own program using the exercises suggested below, or involve a physiotherapist. Begin by doing stretches and exercises at least once a day. Once symptoms improve, continue doing the exercises several times a week.
- Lose weight. Excess body weight contributes to plantar fasciitis. Weight loss will help prevent symptoms from returning.
Need more help?
Remember, it can take four to eight weeks for plantar fasciitis symptoms to improve while using the tips above. If no change appears after trying for three to four weeks, it is probably time to see your family doctor.
Heel pain can also be caused by a stress fracture of the heel bone, inflammatory joint disease, or rupture of the plantar fascia. Foot x-rays may show a heel spur, a pointed growth of bone extending forward from the heel bone. Heel spurs are common with plantar fasciitis, but usually do not cause the pain. The presence or absence of a spur does not confirm plantar fasciitis. Even if a spur is present, surgery to remove it is usually not recommended.
If your symptoms do not improve, your family doctor may consider other treatments. These include custom in-shoe orthotics, wearing a splint at night, shock-wave therapy, and a cortisone injection.
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2015, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6 [AL_FHd08]