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How To Treat Heel Pain

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by Christine Dobrowolski, DPM

Posted Feb 4th 2007,
Read 3425 times since then.

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If you experience a sharp pain in your heel when you first step down in the morning, it is most likely due to plantar fasciitis. Plantar fasciitis is the tearing and subsequent inflammation of the long ligament on the bottom of your foot due to overuse. This type of heel pain may also occur as achiness at the end of the day in the heel or even burning pain in the arch. Plantar fasciitis can be associated with a heel spur, but this is not the cause of the pain. When the long ligament like structure (plantar fascia) on the bottom of the foot pulls on the heel bone over a period of time, a spur is formed. Only 50% of individuals with plantar fasciitis have a bone spur in their heel. The spur will never go away, but the plantar fasciitis will. Plantar fasciitis is typically caused by a new activity, a new pair of shoes, a worn out pair of shoes or change in job. Individuals with flatfeet or abnormal motion in the feet may have a higher chance of developing plantar fasciitis. Once you develop plantar fasciitis, you will find it very difficult to treat.

1. Identify the cause: Once the cause is identified, try to stop or modify the activity.

2. Decrease aggravating activities: If you walk or run for exercise, stop. Try other activities such as swimming or biking. Avoid the stair stepper, the treadmill and the elliptical machine at the gym. Climbing up and down stairs, walking or running on hills, squatting, carrying heavy items and walking on uneven terrain all place excess stress through the feet. Decrease these activities by asking your spouse, significant other or friend for help with the kids or carrying heavy items. Avoid multiple trips up and down the stairs at work and home. Limit gardening to flatter more even terrain.

3. Trying using an ice massage: To decrease inflammation and pain in your arch, roll your foot over a frozen sports water bottle for at least 20 minutes twice a day.

4. Alternate between hot and cold: This technique is commonly used in physical therapy and is typically referred to as contrast soaks, but there doesnt really need to be any soaking. Start by icing the heel and/or arch for five minutes, then switch to a heating pad for five minutes. Alternate for about thirty minutes two to three times a day. If you can soak in ice water and then hot water, this will accomplish the same thing.

5. Stretch your calf: Before you get out of bed, wrap the towel or belt around the ball of your foot. Pull the foot towards you and keeping your leg straight. You should feel a stretch in the back of the calf. This will also stretch the bottom of the foot. Stretch your calf throughout the day with the runner's stretch and spend 5-10 minutes every evening stretching your calf.

6. Take anti-inflammatory medications: Anti-inflammatory medications will help decrease the inflammation that occurs in the fascia as a result of the stress and tearing. Make sure you dont mask the pain. If you continue to aggravate the fascia, but decrease the pain, you may think you are better, when you are really not. Decrease your activity level and stretch and ice as much as possible during the time you are taking these medications. Take the medication with food and stop taking the medication if you experience stomach discomfort. If you have any concerns, contact your doctor.

7. Wear supportive shoes: A supportive shoe will only bend at the toes. This step may seem logical, but many individuals don't realize that their comfortable shoes lack support and may be contributing to their pain. Test your shoe by taking it, flipping it over and grabbing the toe area and the heel. Attempt to fold the shoe in half. If the shoe bends in half, then the shoe is not supportive. Don't go barefoot. See the American Podiatric Medical Association's (APMA) list of approved shoes at www.apma.org/ seal/sealaccategory.html.

8. Try a night splint: A night splint stretches out the plantar fascia when you are sleeping. Instead of 5-10 minutes of stretching throughout the day, you will be receiving six to eight hours of stretching. There are a number of night splints which can help. Soft night splints, like The Strassburg Sock, tend to be more comfortable for patients and can be bought online. The larger and more rigid night splints tend to work very well, when patients can tolerate them. They tend to be more expensive, but if you are dispensed a night splint at your doctors office, they may be covered by your insurance.

9. Wear orthotics: Prefabricated orthotics are inserts that fit into the shoe to help control motion in your feet. Controlling abnormal motion in the feet can decrease the stress and help the plantar fascia heal. Soft inserts available at the drug store may be comfortable, but they will not help control abnormal motion. Make sure the orthotics you buy are rigid or stiff from the heel to the ball of the foot.

10. See a podiatrist: If your symptoms persist, make an appointment with your podiatrist. Other treatments include prescription anti-inflammatory medication, steroid injections, physical therapy, cast boots, shock wave therapy and surgery. Luckily, very few individuals need surgery.

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