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. And there are more voodoo treatments
available than Carter has liver pills. Why is that? Seems to me that there is a lot of
money in heel pain!
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.
Hmm...Will have to look at that a little closer in the biomechanics lab.
Why does it afflict so many people? Let's think...oh yeah...most of the United States is
overweight. Most people 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 fat and in poor shoes are usually crazy
Now that we know why it seems that everyone suffers from heel pain at some point in
their lives, how can we treat it without breaking the bank? Let's start simple. Better,
more supportive shoes are the key to success. Arch supports 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. (That's tough for more people) 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 possible prescribe arch
supports or orthotics if your need them. An injection or two of an anti-inflammatory
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 aggressive 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!