Why does it seem like there is an epidemic of heel pain in the United States? Everyone I talk to has had plantar fasciitis or at least has heard of it. Many can even spell it correctly. (Isn't that scary!) Most people suffer for months and even years before they seek medical attention. Even those treated with traditional methods seem to take just about forever to get better. So let's take a closer look!
- What is plantar fasciitis?
Simply stated, it is inflammation of the ligament that holds up your arch, also known as your plantar fascia.
- What causes heel pain or plantar fasciitis?
Most experts agree that plantar fasciitis is caused by too much stretching of the plantar fascia, usually because of excessive pronation or flattening of the arch of your foot while you walk. Some people just have excessive stretch because they have flat feet. Others have really high arches and their fascia is under a lot of stress in normal walking. Some are just too heavy. It can be triggered by an injury like simply falling off a curb, excessive stress by a new exercise program, poorly supporting shoes, and many other increases in stress like a new job or carrying heavy objects. There is even one theory that states that plantar fasciitis is caused by weakening of the muscles of our feet from wearing shoes all of our lives.
- Why does it afflict so many people?
Many people in the United States are overweight, and this is definitely a factor in the cause of plantar fasciitis. Most people also choose absolutely awful shoes to wear due to their sense of fashion. Slaves to fashion usually have painful feet! And the flip flop phenomenon has accelerated the epidemic! Those that aren't overweight and in poor shoes are often obsessive exercise-aholics.
- How can we treat it?
Let's start simple. Better, more supportive shoes are the key to success, and arch supports are needed if the shoes aren't enough. You need to stop the stress that caused the arch to strain in the first place. Then treat the inflammation with over-the-counter anti-inflammatories, if you can tolerate them, and lots and lots of ice. Slow down. And gently stretch the arch of your foot and your Achilles tendon.
- When should you seek medical attention?
If you have arch and heel pain for more than three or four weeks, and you have done the simple things to alleviate the pain; it's time to see your podiatrist. Not time to go to the shoe store and spend a bizillion dollars on off-the-shelf inserts and funky "proven to work" shoes. Not time to go to the pharmacy for hundreds of dollars worth of gadgets and creams. Time to see your podiatrist, who is the expert in heel pain.
- How will your podiatrist treat your heel pain?
Every case of plantar fasciitis is different, but some standards of care do exist for treatment protocols for heel pain.
First order of business: You need to rule out anything else by taking an x-ray to make sure it's not a stress fracture or tumor in your heel bone. A physical exam is also needed to assess why you have heel pain. Then your podiatrist will usually assess your shoes and possibly prescribe arch supports or orthotics if your need them. An injection or two of an anti-inflammatories into the heel is often used to break the pain cycle. Physical therapy is also often helpful. A night splint or brace is sometimes used. And if all else fails, you may be put in a cast to rest the area.
Contrary to popular belief, you do not have to suffer from plantar fasciitis forever. Most patients (>85%) will get better with conservative treatment. It is tedious and frustrating, but the diligence and consistency in the treatment protocol yields excellent results.
Here is the bottom line: if you seek the attention of your podiatrist early, you will get better faster and your treatment will not break the bank. Procrastinators will end up spending a lot more money and the chance of needing surgery to alleviate your pain goes way up!