Heel pain doesnt have to sideline your life
By Jeffrey D. Poole, D.P.M., University Foot and Ankle Centers
One of the most common ailments for the lower extremities is some form of heel pain. Nearly 10 percent of the population will develop heel pain at some point and it is largely caused by a lack of elasticity in the plantar fascia ligament that runs from your heel to your toes.
This is most commonly known as plantar fasciitis and if you haven’t experienced it personally, you probably know someone who has.
We see between five and 14 patients a day who are dealing with plantar fasciitis and we feel like we have a very successful regimen for healing this debilitating pain. Many people think once you get it, you have to live with it, but it’s a reasonable expectation to say that people shouldn’t have to live with any degree of heel pain. It shouldn’t be affecting your daily life for a long period of time.
My partner, Caroline Gannon, D.P.M., and I can sympathize. I have had plantar fasciiis before and because we come from athletic backgrounds, we know how important it is to keep mobile—while remaining uninjured.
Root of the pain
You get up out of bed one morning and feel like you are stepping on something under your heel. But even though heel spurs can be part of the problem, studies have shown that they aren’t the cause of the pain. It’s the inflammation of the soft tissue that causes the heel pain because it gets inflamed right at the heel.
As we age, we lose a certain type of collagen in our soft tissues, so the tendons and ligaments become stiffer. You add to that a busy lifestyle that cuts into our stretching time before and after exercise and you have the perfect prescription for your very own case of plantar fasciitis.
We know what works to get our patients back on the road to recovery faster. Our protocol is a four-step treatment plan for patients at home: stretching exercises, ice baths (20 minutes submerged in ice), anti-inflammatory medicines like NSAIDs and adequate arch support.
When you do this combination together, it works. Many times primary care doctors will try anti-inflammatory medicine, or stretching, but not the inclusive protocol we use. People tend to be afraid to see any doctor with heel pain because they’ve heard that custom orthotic arch supports can cost upwards of $600. But we have found that $10-$15 over-the-counter arch supports work just as well if not better in many cases.
We recommend starting with a corticosteroid injection, which jump-starts the anti-inflammatory process. Many times this steroid injection will take effect within 48-72 hours and some people approach 100 percent relief. The majority of people are 50 to 75 percent better within two weeks.
In our office, we have patients back every two weeks to make sure they are following through with what they need to do and to gauge their pain.
Plantar fasciitis can re-flair just as bad or worse if you don’t abide by the two golden rules of continued adequate stretching and proper arch support. That’s when it will come back on you. We are here to educate you on what you can do to keep it at bay.
We can also do a tendon release surgery, which has a high success rate, but we honestly don’t do it much because the success rate with the other therapies is so good.
I tell people you can get plantar fasciitis as early as age 30, because that’s when it happened to me. It can happen sooner than that, but after age 30, the tissues are more likely to get contracted and with busy lifestyles, it’s more likely to occur because of lack of time for preventative measures.
Aside from aging, there aren’t causes of plantar fasciitis. Lack of adequate stretching certainly doesn’t help, but you can stand up and walk to the bathroom and do micro trauma to the tendons in your feet and not even know it.
Stretching stops that micro-trauma that happens every time you walk after sitting or lying down for a long period of time by loosening the tissues and getting them elastic enough so that you aren’t doing damage with every step.
The best way to know you are stretching the right ligaments and tendons is to pay attention to ankle mobility and stretch the Achilles tendon. When you do that, you are secondarily stretching the plantar fascia. For anyone who is active, stretching before and after activity is very important, but even sedentary people can get plantar fasciitis.
Key stretches are non-ballistic, meaning you don’t want to bounce. Keep your knee straight and pull your toes back toward you.
For people who have already experienced plantar fasciitis, I recommend stretching both feet before you even get out of bed in the morning. Do 30 seconds on each foot for a total of three minutes up to three times a day.
Dealing with plantar fasciitis can make you miserable. You see it in people’s faces when they can’t do the things they like to do and it can wear on you emotionally for sure. But it’s important for people to know this isn’t something you have to suffer through and learn to live with. There is relief available for those already affected and stretches to help keep the rest of you at bay.
Jeffrey Poole, D.P.M., is board certified in podiatric surgery, reconstructive rearfoot and ankle surgery. He and his partner, Caroline Gannon, D.P.M., board certified in podiatric and foot surgery, are part of University Foot and Ankle in Franklin and are credentialed physicians at Williamson Medical Center.
Posted on: 1/2/2014