Tenderness in the area shown in the picture is where classical plantar fasciitis is found.  It is, also, known as a heel spur, though this is a misnomer.  There are as many people who have heel spurs who do not have pain as there are people who have the pain and do not have a heel spur.  There is one condition that can be associated with a heel spur along with pain, but that is at the back of the heel at or very near the attachment of the Achilles tendon to the heel.  This is common in women and is known as the “pump bump” presumably from wearing high heels.

The anatomy of the plantar fascia is like an open fan with the narrow part of the fan at the heel and the broad part along the entire bottom of the foot just behind the toes.  It acts as a spring ligament that absorbs some of the force of the foot as it strikes the ground, a chief support for the arch of the foot and a firm attachment for the skin on the bottom of the foot.  If not for the plantar fascia, the skin would move like the skin on the back of your hand and be unable to firmly contact and grip the ground.

Plantar fasciitis is usually found in the over 30 age group and in people engaged in high impact activities, such as, running and , also, in overweight people.  A congenital cause is a turned-in heel.  If you can sit in a chair with your knees bent and the feet off the ground and the heel is turned in toward the other heel, this can be one of the aggravations.  The usual onset of plantar fasciitis is insidious and if this not the case and a sudden onset with possibly a tearing sensation occurs, this more likely is a tear of the fascia and needs immediate professional help.  That will probably need a walking cast applied.  We will be talking in this posting about the pain that comes on with no obvious cause, usually exquisitely painful the first step out of bed in the morning and with no swelling, bruising or pins and needles sensation into the foot or toes.  After the first steps of severe pain it usually abates to a lesser, but very aggravating pain, exacerbated with each step.   The present style of shoe with no heel counter (the part of the shoe that surrounds the heel) is particularly prone to causing or aggravating plantar fasciitis.  More controversial is the present running shoe.  As the years have gone by, the shoe manufactures have made the soles of the running shoes thicker and this does not allow for the natural forefoot strike as the first part of the foot that comes in contact with the ground and forces a heel strike instead.  The natural running stride is like a sprinter’s up on the forefoot and the thick soles of the high end running shoes do not allow this.  If you look closely at a sprinter’s shoe wear it is closer to barefoot then not.  There is a very comprehensive E-book available that will do wonders in dispelling the misinformation.  http://5f9f493olfo1cu9ly6zoff6w4o.hop.clickbank.net/ is the web site that is associated with the E-book in question.  If you are a dedicated runner and suffer from foot pain this E-book is indispensable.

Home exercises are for all cases, but especially if you have turned-in heels.   Standing about 20-24 inches away from a door and bending your knees about 30 degrees while keeping your heels firmly on the floor and then leaning forward putting your hands on the door and then trying to touch the door with your chest is the start of a good set of stretching exercises.  If you feel your feet slipping you need to be slightly closer to the door.  Once you have reached the door then, again keeping your heels on the floor and chest on the door slowly straighten the knees sliding the chest up the door.  This helps stretch the calf muscles and can improve foot flexibility, as well as helping improve the turned-in heel, if present.  Rolling a vegetable can on the floor with the involved foot, as well as massaging the tender area is, also, sometimes helpful.

Most shoe inserts are designed to reduce the shock of the foot fall on the floor and are readily available at any pharmacy , but frequently this is not the problem.  A more likely cause is, not compression, which is the act of the heel striking the floor, but is actually the shear force, that is a sideways slip of the heel in the shoe.  This is especially prominent in the open heel shoes and flip-flops that have already been mentioned.  An inexpensive heel cup that works like putting a glove on the hands before chopping wood to reduce the shear that causes blisters is available through Amazon here.  Many times this will suffice, but if not a visit to a foot and ankle physician or obtaining the E-book would be appropriate.

Steroid injections are sometimes necessary, but this posting is about the treatments that can be tried before resorting to a care provider visit.  Over-the-counter (OTCs) NSAIDS or non-steroid anti-inflammatory drugs are helpful, but again as discussed in other parts of this web site, the dosage on the label is for temporary pain relief and rarely will have a curative effect at that dosage on the inflammation.  The two most available are Aleve and Motrin/ibuprofen/Advil.  My recommendation is Aleve 2 tablets at breakfast, lunch and dinner for a total of six per day with the precautions that stomach or intestinal bleeding can occur and , if there is a history or if actual active ulcer disease is present, then all NSAIDS except Celebrex (requires a prescription and a visit to a care provider) are contra-indicated.  Motrin/ibuprofen/Advil is available, but for anti-inflammatory benefits 12-16 of the 200mgm tablets are required.  All inflammatory problems should be treated as a fire that needs medication constantly given until the fire is out.  Again, this is a different concept then taking motrin for aches and pains, menstrual cramps, etc.

A relatively new treatment, again requiring a care provider visit, is shockwave therapy.  Though found in many cases to be curative, the insurance companies are, for the most part, behind in authorizing payment for the treatments.  Dr. Armendariz of our group (see mission statement) is expert in its use and can frequently convince the insurance companies of the treatment necessity.