• dr puisan

Help!!! It's painful to step on my heel!!!!

Plantar Fasciitis

What is it?

- Plantar fascia is a thick fibrous band of tissue that stretches from the inside part at the underside of the heel bone to the base of the toes. What it does is it provides support to the arch of the foot.

- In the event of too much stress to the plantar fascia, it can become inflamed, thickened and swollen causing pain on the heel or along the arch of the foot. This condition is what we call Plantar Fasciitis.

How does it feel like to have Plantar Fasciitis?

- It is usually a slow occurring issue commonly associated with overuse. Typically, the usual complain will be pain at the heel, especially upon waking up in the morning and taking the first step out of bed. Similarly, there will be pain in the heel during the first step after a period of prolonged immobilization (sitting in a car for a long journey or a movie marathon).

- Early in this condition, the pain eases after walking around but as it is left untreated, the pain worsen and lingers throughout the day.

What causes it?

- Some people are more prone to developing this condition; high body mass index, flat footed, overpronation of feet and very tight calves (typical of people who dismiss stretching on regular basis and people who loves wearing high heels).

- In the more athletic population especially runners, common predisposing factors that will lead one down the road of prolonged pain, discomfort and most times debilitating, of plantar fasciitis are:

1) poor running biomechanics (or running form) where there is over pronation of feet and/or too much heel strike during running gait. This places a lot of stress onto the plantar fascia leading to irritation and inflammation.

2) poor choices of footwear, where there is inadequate support or wrong types of footwear for your foot type/body type. For larger sized runners who are just starting to enter the fascinating world of running and road racing, picking a pair of shoes with enough cushioning and support is important. With the minimalist-type of running shoes still in vogue, sudden changing to shoes with low heel-to-toe drop without adequate adaptation to the shoes will place high amount of stress to the plantar fascia.

3) tight calves from inadequate (or none!) stretching. Stretching post run is highly recommended if not pivotal to the prevention of many overuse injuries, in this case, plantar fasciitis.

4) weak calves, just like tight calves are also contributing factors to one developing plantar fasciitis. A lot of runners feel that running is the only exercise necessary to build muscles in the legs thus forgoing strengthening exercises.

5) different running surfaces makes a difference. Running on tar road and cemented side walks (which are us runners run on) leads to high impact on foot strike landing thus leading to higher stress to plantar fascia.

6) the “dreaded too’s” which is TOO MUCH, TOO SOON, TOO OFTEN. Sudden increment in mileage without adequate rest will most often lead to unwanted aches and pains, one of them very likely could be plantar fasciitis.

7) speedwork and hill repeats. On the topic of too much, too soon and too often, adding on too much speedwork and hill repeats can also lead to the unwanted heel pain.

How to overcome it?

- Now that you are stuck with this heel pain and it is causing you much grievance when you run, these are the few things that you can do to ease the discomfort and return to running in a timely fashion.

1) make sure it really IS plantar fasciitis. There are other ailments that can mimic plantar fasciitis especially in the non athletic population. The best way to to confirm the diagnosis (after your doctor goes through with you your history and physical examination) is to do an ultrasound scan of the plantar fascia, where the fascia is visibly thickened and swollen. Getting xray done may show heel spurs but that rarely is the actual cause of your heel pain. There are many people with heel spurs that do not have heel pain, just as there are many people with heel pain that do not have heel spurs on xrays.

2) if you are a runner and had committed the above causal factors that may lead to plantar fasciitis, then correcting them is the first step to never having to face heel pain again:

- icing post run/walk/prolonged standing.

- proper footwear with adequate cushioning and support. You may consider inserting silicone insoles or insoles that help reduce the flat footedness.

- stretching of both the plantar fascia and your calves. Rolling the painful foot over a tennis or a golf ball helps stretches the plantar fascia and may provide a lot of relief upon first step out of bed. Ideally this is done the moment you wake up.

- strengthening of intrinsic foot muscles and calve muscles. The stronger the muscles, the better you are at preventing re-injury.

- putting into the mix of running on softer surfaces ie rubberized track, grassy field or less technical trail.

- pulling back on the mileage up to 50% and taking a break on speedwork and hill repeats, while letting the pain ease off. Once the pain resolves, slowly adding back the mileage (key word: slowly). Cross training (cycling, swimming, aqua-running) can be a great option to maintain cardiovascular fitness while easing off pressure on the foot.

Other things that can be done:

- soft tissue therapy (or myofascial release therapy) can be done for the plantar fascia, calve muscles, hamstrings, glute muscles

- night splint worn during sleep as it keeps the plantar fascia (and to some degree, the calve muscles) stretched throughout the night

- taping of the plantar fascia and the calve muscles

- topical and/or oral analgesia (not recommended when exercising)

If all the above conservative management does not help:

- corticosteroid injection (ideally done under ultrasound guidance to prevent injecting directly into the plantar fascia. Corticosteroid, while it is good to reduce inflammation quickly, can weaken the plantar fascia and may cause it to tear especially in the athletic population. With ultrasound guidance, the corticosteroid will be injected along the surface of the fascia)

- surgery (in refractory cases where there is still pain but all conservative managements have been tried but failed. Not ideal for athletic population

How the Plantar Fascia looks like....(more or less)

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