Arnold S. Ravick, DPM
Arnold S. Ravick, DPM, spokesperson for the American Podiatric Medical Association and is in private practice in Washington, DC.
As usual you get out of bed in the morning… and then something very unusual happens — a knife-like pain stabs the bottom of your heel. This is not normal, you think, and it hurts. The cause may be plantar fasciitis (pronounced fashee-EYE-tiss). While the condition sometimes comes on gradually, it can also start suddenly, for no apparent reason. But whether chronic or acute, plantar fasciitis can cause excruciating pain.
According to Arnold S. Ravick, DPM, spokesperson for the American Podiatric Medical Association and a podiatrist in private practice in Washington, DC, plantar fasciitis is complicated and involves a number of factors, all of which must be addressed, making it especially tricky to treat.
The plantar fascia is a thick band of tissue that runs from the heel to the toes, covering the bones making up the bottom of the foot. Normally the fascia helps absorb shocks to the foot and also supports the arch, but if something causes it to tighten up, small tears can develop causing inflammation and irritation. Stretching may ease the pain but prolonged stillness, as in sleep, causes the fascia to constrict again — this is why it hurts when you take your first few steps each day. Some principal causes of plantar fasciitis are physical exertion such as long-distance running, having a job that keeps you on your feet, being overweight, having flat feet or an unusually high arch, and just getting older, if you’re one of those in whom the fascia begins to shorten or tighten, thereby putting pressure on the fascia. Dr. Ravick says plantar fasciitis can also develop from an incorrect gait, in particular a pronated one (turning in), but an injury might also alter a previously good gait and end up overstressing the bottom of the foot.
Unfortunately, once it develops, plantar fasciitis can last as long as nine months to a year. He says pain in your heel or elsewhere on the bottom of the foot, including at the center, should alert you to possible plantar fasciitis — especially if it goes on a month or longer and continues to worsen. Don’t put off seeking treatment, as the sooner you get started, the faster your heel will heal.
If plantar fasciitis is diagnosed, the first step will likely be taping the foot for several days to partially immobilize the muscles and lessen the cycle of tightening and loosening, says Dr. Ravick. Patients should avoid stretching at first, and then once told to do so, begin stretching the arch, toes and Achilles tendon, a regimen they’ll need to follow faithfully for many months, even after symptoms subside. Keep weight off the foot by limiting how much you walk, and eliminating all high-impact activity including running. And most will also need some kind of support in both their shoes. The inexpensive inserts available at drugstores can work if they are arch-supportive and rigid, unless your problem is caused by an incorrect gait, says Dr. Ravick. Gait issues must be corrected with special customized orthotic inserts, available through podiatrists. Another treatment approach sometimes used is a special foot/ankle splint, to be worn at night to stretch out the fascia and Achilles tendon. Although simple versions of these are available from foot-specialty retailers, it is best to seek professional evaluation and fitting through a licensed provider since optimal timing for their use varies from patient to patient.
For pain relief, Dr. Ravick advises NSAIDs and applying heat on the affected area. Interestingly, he disagrees with conventional advice to use ice — he says doing so further tightens the fascia. While doctors will sometimes recommend a cortisone shot to alleviate severe pain, it’s best as part of an overall treatment plan, since this might serve to weaken the fascia. Though surgery can be an option, it’s seldom necessary, unless there are special issues, such as bone spurs. Some doctors are experimenting with new and different treatments, including shock wave therapies and endoscopic surgery. Naturopathic physicians also have expertise in treating this problem naturally, with a wide range of alternatives including hot/cold treatments, anti-inflammatory botanicals, supplements, phonophoresis (a way of delivering treatment via ultrasound) and more. Physical therapy can be helpful too.
While about 15% of people will have an ongoing problem with plantar fasciitis, Dr. Ravick has strategies to help avoid recurrence — and, better yet, to help avoid the problem in the first place.