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Treatments to Relieve Painful Plantar Fasciitis

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Bottom Line/HEALTH: I’ve watched teen athletes limp through my house for years, suffering from something called plantar fasciitis, which causes severe heel pain. But the truth is, this isn’t a teen ailment. It’s going to hit one in 10 adults. You don’t have to have it, and if you have it, how do you get rid of it? This is what we talk about at Bottom Lines Conversations With the Experts. I’m Sarah Hiner, president of Bottom Line Publications, and today I’m thrilled to be talking to Dr. Johanna Youner, one of the leading podiatrists and foot experts in private practice in New York City. Welcome, Dr. Youner.
Dr. Johanna Youner: Thank you, Sarah. It’s great to be here.
Bottom Line: So, teens…adults…severe pain. Tell me about what plantar fasciitis is.
Dr. Youner: Absolutely. Plantar fasciitis is an inflammation of the arch that attaches into the heel. Specifically, you have a ligament that attaches right into the heel bone, and the plantar fascia is this entire ligament. Fasciitis happens when you have inflammation right at this area, right on the side of the foot, which affects the entire back of the heel.
Bottom Line: It’s interesting, actually, because you think of it as a heel injury, when in fact it’s an arch injury.
Dr. Youner: Absolutely. Plantar fasciitis is considered heel bursitis. Plantar fasciitis, heel spur syndrome. They’re all the same thing.
Bottom Line: Interesting. Let’s talk about the causes of this. First let’s talk about those poor teens that were limping through my house. All of them were athletes. What’s going on for the athletes?
Dr. Youner: When we take one step walking, it’s three times our body weight. When we’re running, it’s seven times our body weight, and the body just can’t absorb the shock. So it’s a lot of trauma to an area. So they’re inflamed, they’re hurt, they’re bruised, they’re literally bleeding into their heels. The answer to that is rest and ice and taking some time away from the sport.
Bottom Line: How about all those one in 10 adults? Do they have a similar kind of pounding problem?
Dr. Youner: Most adults who get plantar fasciitis get it from unsupportive shoes. The foot will naturally pronate or flatten, and it will put a strain on the fascia. So it will start to pull on the heel. If it pulls enough, it creates a little tiny spur from the heel bone going this way. If it pulls enough after a spur, it’ll start to bleed, and then the bleeding will create an entire bursa sac here, and you won’t be able to stand up in the morning.
Bottom Line: You mentioned, though, unsupportive shoes for the adults. All those kids are running around in cleats. None of those shoes have support in them, either.
Dr. Youner: In a younger person, it’s not as degenerative. It can be a different cause of the plantar fasciitis. In older people, they have found that degeneration is a large cause of plantar fasciitis in adults. In teens, it’s trauma.
Bottom Line: You mentioned for adults, rest.
Dr. Youner: Rest and support. Rest, ice and support. Not complete rest, but if you have a severe case, you may need to be put in a walking boot. If it’s a mild case, support. You must wear supports. This is where there is no negotiation with your doctor. You need supports—either over-the-counter, medical grade or custom supports. With the support, the arch is supported here, so the heel is left free, so this can heal, the inflammation can go down. If you do not support it, it will not get better.
Bottom Line: And same thing—support whether you’re a teen or whether you’re an adult? Same strategy?
Dr. Youner: Absolutely. Support and off-weighting the area. Custom orthotics come into play to support and off-weight the area.
Bottom Line: Does it come on suddenly, or is it kind of a slow-growing injury?
Dr. Youner: Both. If it’s a sudden injury—again, teen athletes, after a game, too sharp an injury, the fascia is injured. In an adult, if you’re walking across town in shoes, the fascia is pulling, making it bleed; over a couple of weeks, you start to notice pain in the morning, swelling. Then you can’t put your shoes on.
Bottom Line: Should somebody start to pay attention when they first start to get some kind of discomfort in their arches?
Dr. Youner: If you have foot pain, it is not normal. If you have any foot pain, you need to seek help. If it’s arch pain, if you know the reason—say you wore a pair of shoes that were unsupportive or not right for the job…or you went to theater and dinner wearing the wrong shoes—you rest it for a day or two. If it doesn’t get better, it’s time to seek help.
Bottom Line: And can you heal it completely?
Dr. Youner: Not necessarily. Sometimes it is torn, and sometimes that tearing needs to scar to heal.
Bottom Line: Once somebody’s had it, are they now prone to some kind of heel problem in the future? Again, I’m thinking of young people looking at their future sports life.
Dr. Youner: If you have a weakened ligament, you may be prone to further injury for the rest of your life.
Bottom Line: Let’s talk about what they can do to prevent it.
Dr. Youner: Number one is support—support by custom orthotics or medical grade, over-the-counter orthotics, of which there are many available these days. They will support, off-weight that heel where the fascia—again, the fascia is attaching over here. You need to off-weight this area. If you do not, it will not heal. If you wear supports, if you take medication if it’s a very bad case, some anti-inflammatories, rest, ice, you’ll heal it.
Bottom Line: And again, the support primarily for the adults. How about the young people?
Dr. Youner: Young people need support as well, especially in sports.
Bottom Line: Because young people wear so many shoes that are nonsupportive shoes—such as flip-flops—are they setting themselves up more than past generations for a lifetime of foot problems?
Dr. Youner: Not really. Young people heal very quickly. It’s not really that—my concern is about the sports shoes. As long as they’re wearing the correct shoes for the sport, they should be OK.
Bottom Line: All right. Thank you, Dr. Youner. The bottom line on plantar fasciitis? See the podiatrist, and then rest and ice. There’s no way around needing to rest and calm down that ligament. Beyond that, you need support on your feet. If you’re a young athlete, you’re going to need to rest as well. This is Sarah Hiner with Bottom Line Publications.
 
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Source: Johanna S. Youner, DPM, a podiatric surgeon in private practice and attending physician at New York Downtown Hospital, both in New York City. Dr. Youner is a board-certified foot surgeon and a Fellow of the American College of Foot and Ankle Surgeons. HealthyFeetNY.com

Date: September 29, 2014 Publication: Bottom Line Health
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