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Ten Tips for Treating Heel Pain By Christine Dobrowolski, DPM The most common cause of heel pain 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 type of heel pain may also occur as achiness at the end of the day in the heel or even burning pain in the arch. Plantar fasciitis can be associated with a heel spur, but this is not the cause of the pain. When the long ligament like structure (plantar fascia) on the bottom of the foot pulls on the heel bone over a period of time, a spur is formed. Only 50% of individuals with plantar fasciitis have a bone spur in their heel. The spur will never go away, but the plantar fasciitis will. Plantar fasciitis is typically caused by a new activity, a new pair of shoes, a worn out pair of shoes, a change of routine or change in job. Individuals with flatfeet or abnormal motion in the feet may have a higher chance of developing plantar fasciitis. Once you develop plantar fasciitis, you may find it very difficult to treat. Identify the cause. There is typically a reason for the development of plantar fasciitis, but since the condition is not typically associated with an acute injury it may be hard to remember. Once the cause is identified, try to stop or modify the activity. Decrease aggravating activities. Climbing up and down stairs, walking or running on hills, squating, carrying heavy items and walking on uneven terrain all place excess stress through the feet. Decrease these activities by asking your spouse, significant other or friend for help with the kids or carrying heavy items. Avoid multiple trips up and down the stairs at work and home. Limit gardening to flatter more even terrain. Stop running and walking for exercise and try biking or swimming. Avoid the stair stepper, the treadmill and the elliptical machine at the gym. Stop running or walking. Keeping up aerobic activity is important and cross training can help. Try biking or swimming. Most walkers hate the stationary bike at the gym, but this isn't forever. Don't drop your heel when you bike and try to avoid standing and climbing steep 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 through the arch because of the position. The classic stationary bike may be more appropriate. Try using an ice massage. Freeze a sports water bottle and place it on the floor. To decrease inflammation and pain in your arch, roll your foot over the water bottle for at least 20 minutes twice a day. Alternate between the frozen water bottle and a heating pad, at 5 minute increments, for 20-30 minutes a day, three to four times a week. Stretch your calf. Before you get out of bed, wrap the towel or belt around the ball of your foot. Pull the foot towards you, keeping your leg straight. You should feel a stretch in the back of the calf, and this will also stretch the bottom of the foot. Stretch your calf throughout the day with the runner's stretch and spend 5-10 minutes every evening stretching your calf. Take anti-inflammatory medications. Anti-inflammatory medications will help decrease the inflammation that occurs in the fascia as a result of the stress and tearing. Make sure you decrease your activity level and stretch and ice as much as possible during the time you are taking these medications. Otherwise, you may end up only masking the pain. Take the medication with food and stop taking the medication if you experience stomach discomfort. Wear supportive shoes. A supportive shoe will only bend at the toes. This step may seem logical, but many individuals don't realize that their comfortable shoes lack support and may be contributing to their pain. Test your shoe by taking it, flipping it over and grabbing the toe area and the heel. Attempt to fold the shoe in half. If the shoe bends in half, then the shoe is not supportive. Don't go barefoot. See the American Podiatric Medical Association's (APMA) list of approved shoes at www.apma.org/ seal/sealaccategory.html. Strengthen the muscles in your feet. Place a small towel on the floor and curl your toes on the towel as you bring the towel towards you. Place marbles on the floor and pick them up with your toes and place them in a bowl. Wear orthotics. Prefabricated orthotics are inserts that fit into the shoe to help control motion in your feet. Controlling abnormal motion in the feet can decrease the stress and help the plantar fascia heal. Soft inserts available at the drug store may be comfortable, but they will not help control abnormal motion. Make sure the orthotics you buy are rigid or stiff from the heel to the ball of the foot. See a podiatrist. If your symptoms persist, make an appointment with your podiatrist. Other treatments include prescription anti-inflammatory medications, steroid injections, night splints, physical therapy, cast boots, shock wave therapy and surgery. Luckily, very few individuals need surgery. Christine Dobrowolski 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. Articles by Dr. Christine Dobrowolski, DPM Recommended Products at Northcoast Footcare.com Deluxe Heel Pain Kit Superfeet Orthotics