"It Hurts When I Step Down In The Morning!" is something we hear everyday in our Thousand Oaks, CA Podiatry office. Several times a day in fact. Heel pain is one of the most common reasons people see a podiatrist.  Although it is common, it is not normal and you shouldn't suffer from or deal with the pain.  Plantar fasciitis is the most frequent cause of heel pain.  The plantar fascia is a band of tissue that starts on the heel bone and extends all the way through your arch to the ball of your foot.  The origin of the fascia on the heel bone gets inflamed and is very painful.  There is usually a mechanical cause for the pain such as new or increased activity, new shoes or weight gain.  Also, some foot types are predisposed to developing plantar fasciitis and it may have little to do with activity or shoes.  The mechanical cause eventually causes inflammation which then causes pain.  Sometimes a bone spur forms due to the pull of the fascia but is not often the source of pain.  

The pain is usually pinpoint on the heel, often more towards the inside of the heel.  It is most painful when stepping out of bed in the morning or when standing up after being seated for awhile.  It is very sharp and knife-like.  It starts off being only slightly bothersome but can progress to causing pain all day everyday and even cause you to limp.  If ignored, the pain can lasts for months to years.

The mechanical cause of pain should be addressed first and foremost.  That can be done with orthotics which are shoe inserts that support the arch and thus take tension off the fascia (reducing pull on the heel bone).  Supportive shoes are also very helpful.  An optimal shoe does not fold in the middle of the shoe (only at the ball of the foot) and has laces.  If your heel is hurting, do not wear flip-flops or other flexible shoes and do not walk around barefoot, even in the house.  

Supportive shoes and orthotics will reduce tension on the fascia, but there is still inflammation which causes pain.  Icing is a good way to reduce inflammation.  Rolling your heel and arch over a frozen water bottle is a good way to massage and ice the foot at the same time.  Oral or topical anti-inflammatories can also be helpful.  Oral anti-inflammatories work best when taken consistently everyday for about two weeks.  A steroid injection into the heel is the best "quick fix".  It works by directly blocking inflammation at the source.  However, there is too much of a good thing and most doctors agree that giving more than 3 steroid injections into the same area within a year can be harmful to the neighboring healthy tissue (thus, only 3 steroid injections into the heel allowed per year).  Even though steroid injections can be very helpful, you still need to be diligent with good shoes, orthotics, stretching and icing.

The Achilles tendon has fibers that wrap around the back of the heel and form part of the fascia.  For this reason, Achilles stretches can be very helpful in reducing tension on the fascia.  Stretches need to be performed at least twice daily for several weeks.  Massaging the heel and arch with a golf ball or tennis ball is also very helpful.  A night splint is something that is worn while sleeping or at rest and holds your foot 90 degrees to your leg to place a constant stretch on the Achilles.  This can greatly reduce the amount of pain when stepping out of bed in the morning.  

Other treatment options include physical therapy, a walking cast, a fracture boot, or taping the foot.  Avoid high impact activities such as walking, running, or hiking and try cycling or swimming instead.  Carrying extra weight can frequently cause heel pain so it is important to eat healthy and perform low impact exercises.  Surgery is the last resort and usually not warranted since most people get better with the conservative treatment.

Heel pain is not always caused by plantar fasciitis so it is important to see your podiatrist for proper diagnosis.  Because there are so many treatment options, it is best to discuss with your podiatrist what is right for you. Please visit our website at www.advpodiatric.com for more information and how to get in contact with one of our doctors. Heal the heel pain.