Are the First few steps in the morning giving you Pain? 

Do you walk like a penguin in the morning? 

Most of us suffering from heel pains think that this might be due to overuse and will get well by itself. In most cases, low intensity pain persists which suddenly increases after a long time and makes walking difficult when you walk after every period of rest/inactivity. The pain typically occurs in the heels initially which if left untreated might also extend to the forefoot and the sole. This entity is medically known as PLANTER FASCIITIS. This is a completely curable problem which needs immediate attention. This basically occurs due to a swelling or inflammation involving the thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes. Due to a deficient blood supply of the fascia in comparison to a muscle or bone, the healing time is prolonged. It usually takes about 4-6 weeks of consistent lifestyle changes and exercises along with medical treatment to get walking like before.The basic cause is a combination of:

  • Overuse
  • Nutritional deficiency
  • Uncomfortable foot-ware
  • Flat foot
  • Obesity
  • Activity related 

The patient comes with a stabbing morning pain in usually both heels initially. Then this starts to come after every period of rest during the day on first few steps. Diagnosis is essentially clinical and requires no investigations. Sometimes an underlying bony spur (outgrowth) has to be ruled out in recalcitrant cases which may require an X-Ray facility. The treatment is essentially conservative with the following tips: 

1. Change of footwear: Use Flats with a cushioned surface, preferable soft sole sports shoes. Also, advised is a silicone soft heel pad for typical heel pain and a silicone insole for pain extending into the foot. Refrain from using a pencil of a tip heel. This causes Foot and ankle arthritis. 

2. Stretching exercises: Take adequate rest and restrict your activity to essential things only. Stretch your sole and calves doing the exercises as shown in the picture. 10 repetition each with a count of 10 should be done twice a day. Can be done anywhere and does not require any special equipment.

3. Contrast Bath: A contrast bath means using water of two contrasting temperature. Cold brings the inflammatory mediators in blood circulation and hot washes them away with vasodilation. Keep both feet in hot water for 3mins and alternate with cold fomentation for 1 mins simultaneously. This has to be repeated 3 times in one go and do it in morning and evening.

4. Nutritional supplementation: Vitamin D and B deficiency essentially pre-dispose to this condition and aggravate the basic cause. It is must to supplement with the fore-mentioned vitamins in the diet.

5. Medical treatment: Essentially includes an anti-inflammatory and analgesic medication to mask symptoms and reduce on-going inflammation. It is advised to start with all modalities and follow a holistic approach to the problem. This can also be supplemented with physiotherapy and electrotherapy for accelerated healing and pain relief. Class III laser or ultrasonic message are great adjuncts to treatment. In recalcitrant cases, it is essential to see your orthopaedic surgeon and physiotherapist.