Got Foot Pain? Get Relief!                                       Plantar Fascitis (Fasciosis)/Heel Spur Syndrome

By Robert P. Nirschl M.D., M.S.

Heel pain affects nearly 2 million Americans each year and up to 10% of the U.S. population over a lifetime. Plantar fasciitis is the most common cause of heel pain and the most common orthopaedic complaint relating to the foot that we see at Nirschl Orthopaedic Center. 

The plantar fascia is a large ligament/tendinous structure that runs along the bottom of the foot.  It attaches to the heel bone (calcaneus) and the base of the toes (ball of the foot).  The plantar fascia helps support the bottom and arch of the foot. 

Pain in the heel is due to degeneration in the tendon and inflammation of surrounding tissue.  As you step down, the irritated tissue pulls on the bone, which causes pain. The condition called Plantar Fasciosis, can become chronic lasting months or years. 

The irritated plantar fascia tissue becomes degenerated and unhealthy if it is repeatedly overstretched. (If stress happens over a long period of time, the heel bone responds by laying down more bone where the plantar fascia attaches to the heel, thus creating a heel spur). It is commonly believed that these spurs point downward because stepping on it feels like stepping on a tack. The spur actually runs parallel along the bottom of the foot, pointing toward the toes. Typically, the heel spur itself does not cause pain, but reflects a long standing chronic bone reaction to the stretching tension of the plantar fascia on the bone.

What causes undue stress on the plantar fascia?

  • Foot structure — an arch that is either too high or too low (e.g. flat feet)
  • Excessive pronation — the feet roll inward too much when you walk 
  • Heavy use — either an occupation that requires long hours of standing and heavy lifting, or participation in sports that require a lot of leg and foot movement, or being overweight
  • Ill-fitting shoes with poor arch support
  • Tight calf and hamstring muscles — causes a tug of war over the ankle and foot joints. Note – prolonged periods in high heels or using heel lifts in shoes can cause tight calf muscles.

The heel pain is usually due to a combination of several these causes.  Therefore it takes a combination of exercises, control of overuse by bracing and other treatments to affect a solution. An experienced doctor or physical therapist can evaluate you to determine what your problem areas are and what treatment is appropriate.

Pain may develop slowly, over time, or suddenly after intense activity. It is usually worse: 

  • In the morning when you take your first steps
  • After standing or sitting for a long time
  • When climbing stairs
  • After intense activity 

What can you do?

  • Give your feet a break. Cut back on activities that make them hurt
  • Apply ice to the painful area. Do this at least twice a day for 10 - 15 minutes, more often in the first couple of days. Keeping tennis balls or a water bottle in the freezer and using them to perform a foot massage by rubbing your foot over the ball or bottle is a convenient technique 
  • Take an over-the-counter anti-inflammatory pain reliever such as Advil, Motrin, or Aleve
  • Do foot, heel, and calf stretching exercises several times a day. 
  • Pick shoes with good arch support and a cushioned sole
  • Try heel cups shoe inserts. Use them in both shoes, even if only one foot hurts. *This is a short term fix as prolonged use of heel cups will make the calf muscles tighter*
  • Wear a night splint while sleeping to help stretch the foot/fascia
  • Try Physical Therapy
  • Count’R-Force arch brace (pictured below) is often helpful 

Even with the correct exercises, some people have abnormal foot mechanics or abnormal structural alignment that continues to place too much stress on the tissues. These problems can be present for several years before pain occurs, but will continue to cause discomfort if not corrected. Prescription orthotics (custom molded inserts that fit into your shoes) may be required to correct these structural problems.

Nirschl Orthopaedic Center is a leader in sports medicine and general orthopedic services. In addition Virginia Sportsmedicine Institute physical therapy has been rated one of the top sports medicine clinics in the area. If you have an orthopaedic injury, schedule an appointment with one of our doctors today. Visit our websites at nirschl.com and vasportsmedicine.com to learn more about our services. For more info on orthopaedic issues visit our blog at nirschlorthopaedic.com. Follow us on Twitter @nirschlortho

Nirschl Orthopaedic Center for Sports Medicine & Joint Reconstruction
1715 N. George Mason Drive, Suite 504
Arlington, Virginia 22205
703-525-2200 

© Jane Voigt Tennis 2013