Q: When my feet hit the ground after a good night’s sleep, the pain in my heel is sometimes unbearable. After I walk around for a while it seems to loosen up and I can get through the day. But sometimes I don’t even want to get out of bed in the morning the heel pain is so severe. What’s going on?
A: Without the benefit of an examination, I’d say it’s a pretty good bet you’re suffering from plantar fasciitis, a common cause of heel pain that classically shows up as sharp discomfort first thing in the morning. Pronounced PLAN-tar fash-e-EYE-tis, it is a condition caused by small tears and inflammation in the thick band of fibrous tissue (fascia) that runs along the bottom (plantar surface) of the foot, from the heel to the base of the toes.
As you note, the pain usually subsides once you start walking and limber up, but that doesn’t mean your foot is getting better. You may find the heel pain returns during the day after long periods of standing or if you stand suddenly after you’ve been sitting for a while.
Once you pinpoint the probable cause of your heel pain, you can take steps (pun intended!) to minimize the stress on your foot. Then, visit my office so I can do a thorough examination and get you fitted for orthotics, which are molded inserts made specifically for your feet. They’ll act like shock absorbers to cushion your footfalls and gradually help your foot heal. Healing might take 6 months to a year, but I recommend a slow and steady approach to recovery. If you’re not better after that time, we can try some other therapies.
One thing I don’t recommend is ignoring the pain and pretending it will get better on its own. If you do that and compensate for the pain by changing the way you walk, you might be setting yourself up for secondary pain and problems with your ankle, knee, hip, or back.
Pinpoint the Cause of Your Heel Pain
Plantar fasciitis is sometimes called “jogger’s heel” because it often afflicts runners and joggers. But other sports, such as tennis, racquetball, gymnastics, ballet dancing, and dance aerobics can also cause tension and tears in the plantar ligament. Non-athletes can also suffer from it, particularly those with faulty foot mechanics. And by that I mean anyone who has flat feet, or a high arch, or who walks with a foot that rotates inward (pronates) with each step. In addition, people who are overweight or pregnant, or those who stand for many hours of the day on hard flooring (factory workers, teachers, healthcare workers) are at risk for added stress, repeated small tears, and inflammation to the plantar fascia.
If you’re in pain and fall into any of those categories, common-sense remedies can help. For example, if you’re a runner, make sure you’re not wearing old running shoes that no longer support and cushion your feet. Buy new shoes after you’ve logged about 500 miles. Although I know it’s easier said than done, consider changing your sport if your feet take the brunt of impact. Instead, try a low-impact sport, such as swimming or bicycling. Staying active will help you maintain a healthy weight, and that’s important too. Also try to avoid going barefoot, especially on hard flooring.
Other Therapies for Plantar Fasciitis
As I mentioned above, getting custom orthotics is my first choice of therapy to ease the pain and inflammation from plantar fasciitis. These inserts will help distribute your weight and the pressure on your feet more evenly as you stand and walk.
But there are other options to help too. Steroid injections and physical therapy such as ultrasound and hydrotherapy might work for you. Surgery would be our last resort.
Make an appointment to see me if you’ve got heel pain, and we’ll work together to figure out what’s causing it and the best ways to make you feel better.
– Dr. Shier