© SKI Publishing
Ways to Fight Heel
Christine Dobrowolski, DPM
are many different causes of heel pain, but the most common cause
is plantar fasciitis (plan
* tar _fash
* ee * i * tis). If you experience a sharp pain in your heel when you
first step down in the morning, it is most likely due to plantar fasciitis.
This problem is a result of excess stress through a long ligament type
structure (the plantar fascia) in the bottom of the foot. The excess
stress causes tearing and results in inflammation and pain. The classic
symptoms are pain in the heel at the first step in the morning, or
upon rising after long periods of rest. Many will complain of a sharp
pain in the heel when they step out of their car or after finishing
their lunch break. Other individuals only experience heel pain at the
end of the day or during certain types of activity like running, soccer
or tennis. The pain may extend into the arch and feel achy at the end
of the day.
Individuals develop plantar fasciitis for
a variety of reasons. One of the most common reasons for the development
of plantar fasciitis is wearing poor quality or worn out shoes. Another
common reason is starting a new activity, such as walking or running,
after a period of inactivity. Many active individuals develop plantar
fasciitis after incorporating hills, stairs or uneven terrain into
their training routine. A new job that requires standing all day or
switching to a job with a harder surface, like cement floors, may contribute
to it's development. Individuals with flatfeet or excess pronation
(rolling in of the feet) may have a natural predisposition for plantar
fasciitis. Regardless of how the problem started, the treatment is
aimed at decreasing the stress on the arch and decreasing the inflammation.
Identify the cause. There is usually
a reason for the development of plantar fasciitis, but since the
condition is not typically associated with an acute injury it may be hard
remember. The pain may have gradually developed after starting
a new training routine, changing the routine, running or walking on a new
surface, switching shoes, wearing worn out shoes or starting a
job. Once the cause is identified, stop the activity or modify
Avoid aggravating activities. Going
up and down stairs, walking or running on hills, squating, lifting
heavy items and walking on uneven terrain all aggravate this condition.
Try to decrease these by limiting the number of times you go up
and down the stairs and avoiding hills. If you must squat down, keep the
affected foot in front and flat on the ground. Do not lift or carry
heavy items including your kids. Use a stroller or have your spouse,
significant other or friend carry them.
Stop running or walking. Aerobic activity
is important to maintain and cross training can help. Try biking
or swimming. Most walkers hate the stationary bike at the gym, but remember
this isn't forever. Don't drop your heel when you bike and try
standing and hills if you cycle outdoors. If you participate in
spin classes, you may need to modify the class to avoid further injury to
the foot. The recumbent stationary bike may place excess stress
the arch because of the position. The classic stationary bike is
Use an ice massage.
Freeze a sports
water bottle or a juice can and place it on the floor. Roll your
foot over the water bottle for at least 20 minutes twice a day. This helps
decrease the inflammation in the foot while stretching out the
Use a contrast bath. Icing helps decrease
inflammation occurring within a 48-72 hour period. To help decrease
chronic inflammation, try contrasting between ice and heat. Start
with an ice pack on the heel and/or arch for 5 minutes. Switch to a heating
pack or a hot water bath for 5 minutes. Alternate between the two
20- 30 minutes 3-4 times a week. This may be more time consuming
than the ice pack alone, but can bring considerable relief.
Roll a ball under your foot. Take a
tennis ball, soft ball or even a rolling pin and roll your foot
over it to help stretch out the plantar fascia. This can be done while watching
TV or reading the paper. Rolling the foot over the tennis ball
also be done at work if you have a desk job or during a lunch break.
(This should not cause pain. Don't continue if you have pain).
Stretch your calf in the morning. If
you have pain in the morning upon waking, place a towel or a belt
on your dresser. Before you get out of bed, wrap the towel or belt around
the ball of your foot. By pulling the foot towards you and keeping
your leg straight, you should feel a stretch in the back of the
This will also stretch the bottom of the foot. This is not time
consuming or difficult to do, but it does require adjusting to a new routine.
Stretch your calf throughout the day. Spend about 5-10 minutes each evening stretching the calf as described
above or with the runner's stretch. To really help keep the calf
and the bottom of the foot stretched out, try and stretch for 30 seconds,
10 times a day.
anti-inflammatory medications. Anti-inflammatory medications, like naproxen or ibuprofen, will
help decrease the inflammation that occurs in the fascia as a result of
the tearing. You don't want to mask the pain with these medications.
If you decrease the pain with the anti-inflammatory medications
but continue to participate in an activity which causes tearing and inflammation
of the plantar fascia, you are not healing. Continue resting, icing
and stretching while you take the medications. Take the medication
with food and stop taking the medication if you experience stomach
Lose Weight. This is probably the last
thing you wanted to hear. In fact, there is a good chance that
you have gained some weight since the onset of your heel pain due to a
decrease in activity. But, there is no way around the fact that
increased weight on the body transmits to the feet. Increasing the stress
the plantar fascia can worsen plantar fasciitis, making it more
difficult to treat. Eat smart and try to incorporate aerobic activity which
the impact on the feet.
supportive shoes. This step may
seem logical, but most individuals don't realize how many shoes
lack support. A supportive shoe will only bend at the toes. Test all of
your shoes and don't assume your running shoe is a supportive shoe.
Take your shoe and flip it over. Grab the toe area and the heel
and try to fold the shoe. If the shoe bends in half, then the shoe is not
supportive. Don't go barefoot. Get up in the morning, do your stretch
and then slip your feet in a supportive slipper or clog. See the
Podiatric Medical Association's (APMA) list of approved shoes at
- Try anti-fatigue
mats. These mats help
to decrease the stress through the heel and add some shock absorption
to the floor. The mats can be a great asset for employees who work
on a hard surface. You may want to consider them for home if you
spend many hours standing in a workshop or in the kitchen. See the APMA's
list of approved anti-fatigue mats at www.apma.org/ seal/sealaccategory.html.
the muscles in your feet. Place a thin towel on your kitchen floor. Place your foot over
the base of the towel closest to you. Bring the towel towards you by curling
the toes and gripping the towel as it slides under your foot. Place
marbles on the floor and pick them up one by one with your toes
place them in a bowl.
orthotics are semi-rigid inserts that fit into the shoe to help
in your feet. Controlling abnormal motion in the feet can decrease
the stress in the plantar fascia. Soft inserts available at the
drug store may be comfortable, but they will not help control abnormal motion.
- Try a
night splint. A night splint
holds the foot at 90 degrees while you sleep. This keeps the foot
and the calf stretched out all night long. Night splints are an effective
treatment, but can be quite uncomfortable. Some individuals have
luck with the sock night splints than with the rigid splints. These
devices are available online, but may be covered by your insurance
when dispensed by your doctor.
is a podiatrist, runner, and author of "Those Aching Feet:
Your Guide To Diagnosis and Treatment of Common Foot Problems," available
via her publisher, SKI Publishing, and at Barnes & Noble and Amazon.com.
by Dr. Christine Dobrowolski, DPM
Products at Northcoast
Heel Pain Kit