If you’re suffering with chronic pain in your heel or foot, you’re not alone. An estimated one million people visit their doctor each year due to plantar fasciitis, a chronic degeneration or breaking down of the dense connective tissue that runs from your heel to the base of the toes. The function of these muscles called the plantar fascia is to provide support during walking and assists in elevation. This connective tissue or fascia becomes damaged through repetitive strain or chronic micro tears that worsen over time.
Plantar fasciitis is most common in women and in those who are 40 to 60 years old. Some people are more likely to develop it, particularly those who have flat feet, arched feet or who stand for long periods of time. Long distance runners, military personnel and obese individuals are also at increased risk.
Many people describe the pain of plantar fasciitis in their heel on the inside of the foot. It’s usually worse with the first few steps in the morning or after a period of inactivity like sitting on the couch or at your desk. Some people report that the pain lessens slightly with use, but then worsens again after prolonged periods of standing or walking.
There are no lab tests or imaging studies required for diagnosis, but instead is based on your history, report of your symptoms and a medical exam. Your physician will examine your heel where the fascia connects to the foot and move the foot back by bringing your toes toward your ankle. This will likely cause pain if you do in fact have fasciitis.
The good news about plantar fasciitis is that 85 to 90% of people can be treated without surgery. To quickly help with pain relief, regular use of rest and ice is recommended along with 2 to 3 weeks of non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen or ibuprofen. Heel inserts and arch supporting shoes can also lessen the pain along with resting splints that are sometimes recommended to keep the foot in a neutral position while you sleep. Right away you can also begin specific stretches that focus on the Achilles tendon, plantar fascia and other foot muscles.
The wall push is a great place to start. With your heel on the ground and the ball of your foot on the base of the wall, lean into the wall to stretch the plantar fascia for at least 2 minutes at 10-second intervals at least twice daily. You’ll see the condition improve much more rapidly if three sets of wall pushes are performed every hour on the hour. You can also try the towel pickup method. Using the toes of the affected foot, pick up a dry paper towel, drop it and repeat for two minutes once every evening. Follow this up with rolling your foot over the top of a frozen water bottle for two minutes to provide soothing relief.
Other effective options for heel pain include osteopathic manipulative treatments like myofascial release (MRF) and counterstain. MRF is performed by placing pressure around the insertion of the fascia and holding direct pressure there, placed on the inside and outside of the foot. Here’s a video giving you further details: https://www.youtube.com/watch?v=jbmThIN9zsY
Counterstain is a technique where direct pressure is applied with fingertips at the area of tenderness. The foot is manipulated forward, backward, and facing toward the center of the body and away from it to find where the tenderness is the least. This position is held for 90 seconds.
Just like with any health condition, recommendations for each person will be different based on their overall health history. If plantar fasciitis caused by or worsened by obesity, weight management is often part of the initial treatment recommendation. If these approaches are not effective, some individuals also find relief from heel pain through steroid injections and ultrasound therapy. In some cases, your physician may request imaging to look for other abnormalities if your foot pain doesn’t resolve after several months of treatment. And if you’ve been compliant with these non-surgical efforts and continue experiencing pain, surgery may be warranted.
To schedule an appointment with Dr. Ryan, call (423) 886-2004. To find a physician in your area, visit chi memorial medical group. Virtual visits for primary and specialty care are available.