Good Morning!! Ouch…

The morning first steps hurt in the heel, its so bad that all the goodness of that morning is lost. You have to limp before you can place your heel down.

You are suffering from Plantar Fasciitis

also known as Heel Spur/ Jogger’s heel/ Policeman’s heel/ Gonorrheal heel (misnomer)

You may even experience pain in the heel after prolonged period of sitting like watching movies or desk job. Usually runners or joggers or people who need to stand a lot or walk a lot are prone for this kind of pain.

Many patients have tenderness over a point region on the medial (inner) region of  plantar aspect (that touches the ground) of the heel. In severe case the pain may be through out the plantar aspect of the foot. It may also present behind the heel over the back side of the ankle.

It’s a self limiting degenerative disorder- will explain each term subsequently.

It’s a degenerative disorder- means increased wear and tear of the fascia or group of muscles forming a band. This band/ fascia is attached to the medial plantar tubercle of the calcaneum- which is the inner and lower most part of the heel. When your heel touches the ground the layers of tissue which contact the surfaces are from outer to innermost- thick skin- plantar fat pad-plantar fascia- calcaneum (heel bone). So your fascia is constantly rubbing against your heel bone where it is attached.

So more you stand/ walk/ jog/ run the more wear and tear of the plantar fascia. There are certain individuals who are more prone. People who have Pes Planus (flat foot), Pes Cavus (high arch), limb length difference, diabetes, hypertension, rheumatoid arthritis and other mild form of arthritis are more prone for this disorder. Most patients start having pain when they have changed their footwear, wearing loose or too tight footwear, walking or running bare feet- these all reasons change the bio-mechanics of the foot and so the unnatural wear and tear of the fascia increases, leading to pain.

Heel Spur- seen on Xray a bony tip extending out from the heel bone. That’s where the fascia is attached. Its because of repeated micro-trauma that the extra bone is formed. But it DOES NOT quantify the disease severity. Because someone with no spur can have severe pain and vice versa. So do not be fooled that the bone has grown that’s the reason for pain. It’s the repeated bouts of inflammation that has caused the extra bone formation. It’s a protective mechanism like the skin over knuckles of boxers are thick- same way.Diagnosing and treating the plantar fasciitis early is very important as it can be completely cured and professionals can start regular running exercises!! But the reason for the start of pain should be properly found out.Icing, analgesics and anti-inflammatory medicines help to reduce pain temporarily.Physiotherapy exercises like Tendoachilis (tendon at back of your ankle) stretching, walking on your toes for few minutes after waking up in morning or after long time sitting and wearing well padded shoes in your heel region helps in allowing the fascia to heal. It takes no more than 12 months for it to heal completely (self limiting), but if you take good care, healing will be early. If followed according to advice of your Orthopedic surgeon, you will start feeling positive results in 2 weeks.

Some people with flat foot or other altered bio-mechanics need to be tested and given footwear modifications like medial arch support, sturdy/ strong counter of the shoes etc. Runners must change shoes every 400 kms or see that once the padding is lost they must change shoes.

90% patients do get better with above therapy. But in remaining 10% the healing is not complete. If pain does not reduce after rest, physiotherapy and footwear change there are other treatment options-

Splints or plaster to relieve stress on the heel and reinforce rest to the affected part.

Corticosteroid injections- a very mild steroid along with anesthetic agent given at the insertion of your fascia. If given correctly it directly reduces the inflammation and relieves pain in 2 days.

Autologous blood and Platelet rich plasma injections- help in increasing the fibroblastic activity which directly help in healing.

Botulinum Toxin-A, Cryosurgery and Radiofrequency debridement are still experimental.

Extracorporeal Shock Wave Therapy- helps increase the blood flow and hence the healing. Its US-FDA approved, but costlier and also not covered in insurance.

Surgery- fasciotomy- wherein the insertion of the fascia is released partially.

All the above procedures have pros and cons, which need to be discussed with your treating doctor.

This article is to make you aware of the basics of the Plantar fasciitis and outline the treatment modalitites. You must consult your Orthopedic surgeon in case of heel pain as many other pathologies give rise to heel pain like- Haglund deformity (swelling over back of your ankle), stress fracture of calcaneum, infection and many more. So be aware, be educated and do not hide your pain, share it with your doctor and get treated earlier.