Heel pain, heel pain, heel pain. On the average we see three to five cases of this a day, times thirty years of practice, equals an epidemic of heel pain. If you’ve been putting up with heel pain, you know how fatiguing it can be. The answer to the question above, is “No, don’t cut your foot off!”, even though some of my patients are ready to do just that. First let me review the major factors responsible for heel pain and plantar fasciitis.
#1 plantar fasciitis most commonly involves an inflammation of the attachment of the plantar fascia (flat ligament) at its origin on the bottom of your heel bone, the calcaneus.
#2 It is often, but not necessarily associated with a foot that is flat or one that pronates excessively (collapses the arch) while walking
#3 It is aggravated by standing on your feet all day, athletic activities, obesity, poor shoes, and what I often call the “X” factor, Equinus=tight Achilles tendon/calf muscle.
Therefore, regardless of whether you have orthotics or not, if you have inflammation then it must be treated. We’ve become a lot more proactive about this and are now using a nice combination of ice, topical analgesic, Biofreeze, and a topical anti-inflammatory compounded by our pharmacy to attack inflammation more successfully. You must reduce the pain to be able to restore more normal walking.
Patients will find themselves walking on their toes to avoid the pain, and this will simply make the pain worse. A new, plantar fascial strap that is removable may also be of great benefit in reducing the pain and inflammation.
If you’re already wearing some type of over the counter arch support, it may be time to have an orthotic fabricated that will truly match your foot type and rebalance the faulty foot mechanics. If you have orthotics, an annual check on them will help determine if they are in need of a tune up or replacement. Non supportive shoes will not allow the orthotic to do its job, and your feet may still pronate excessively. Have them checked by your podiatrist to see if you’re wearing the right shoe for the right activity.
Finally, and possibly most importantly, you must address the “X”factor, tight calves/Achilles tendon. This is best treated by a daily stretching program, use of an Achilles splint, and with chronic cases Dr. Berg will dispense a firm heel lift and prescribe physical therapy.
Very few cases of plantar fasciitis require surgical intervention. If your heels are killing you, have your feet evaluated by your podiatrist, and be sure you’ve exhausted all conservative measures. Once the most significant causes are identified, the problem can usually be rectified fairly easily, and get you back to your daily activities pain free.
Rion A. Berg, DPM
Podiatrist and Board Certified Foot Surgeon
Foot and Ankle Center of Lake City
2611 NE 125th St., #130
Seattle, WA 98125
Dr. Berg is available to speak at your association, civic group, Meet-up group, or medical staff in-services in the North Seattle area. Please call 206.368.7000 or email [email protected] to make arrangements.