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Monthly Archives: November 2012

Heel Pain-Plantar Fasciitis

The most common cause of heel pain is a condition called plantar fasciitis. The plantar fascia helps to support the arch of the foot and is a flat band of fibrous tissue that is triangular in shape, originating at the heel bone and becoming broader and thinner as it extends to the ball of the foot. Plantar fasciitis is a condition where the plantar fascia becomes inflamed due to over-use or over-stretching.

One of the most common symptoms of plantar fasciitis is pain under the heel which is most severe after periods of inactivity usually first thing in the morning or after sitting for long periods of time. The pain often improves quite quickly but then returns after prolonged standing or walking.

Factors that can contribute to over-stretching of the plantar fascia include:

–          Over-pronation (where the arch of the foot lowers excessively when the foot hits the ground)

–          Standing/walking on hard surfaces for long periods of time.

–          Being over-weight

–          Having tight muscles and tendons in your feet and legs

–          A sudden increase in activity

There are a number of things that you can do yourself in the treatment of plantar fasciitis:

–          Rest, or reduce your level of activity. Because the plantar fascia is inflamed, it needs to be given a chance to recover. Switch to non-weightbearing activities such as cycling or swimming, avoid running, going barefoot, walking long distances, walking up or down hills, and standing for long periods of time as much as possible for at least 6 weeks. This will give your body a chance to repair the damaged tissue in the plantar fascia.

–          Stretches. Many people with plantar fasciitis also have tight calf muscles. Tightness in the calves puts extra strain on the plantar fascia, so it is important to stretch these muscles. Some helpful exercises for stretching the plantar fascia as well as the calf muscles and Achilles tendon include:

1.      Tennis/golf ball exercise: While seated, roll a tennis or golf ball under the arch of your foot, back and forth from the heel to the ball of the foot. If this isn’t hurting, you can progress to doing the exercise standing up. Keep rolling the ball for 5 minutes.

2.      Towel stretch: Roll up a towel lengthways so that it is long and thick. Holding the towel at both ends, place the middle of the towel under the ball of your foot. Gently pull the towel towards you while keeping your knee straight. Hold this position for 20 seconds, and repeat 4 times.

3.      Calf stretch: Facing a wall, place both of your hands flat against the wall at about eye level. Put one leg a step behind the other leg. Bend your front knee, while keeping the heel of your back foot on the floor, until you feel a stretch in the calf muscles of the back leg. Hold the stretch for 20 seconds, repeating 4 times.

4.      Achilles tendon stretch: Standing on a step, slowly lower your heels over the edge until you feel a stretch in your Achilles tendon and lower calves. Hold the stretch for 20 seconds, bring your heels back up to the level of the step, and repeat 4 times.

Try to do these exercises first thing in the morning and then another 2 or 3 times during the day.

–          Ice and anti-inflammatories: Applying an icepack directly onto the affected area for 5-10 minutes, 3 times a day, will help to reduce the inflammation. Anti-inflammatory medications such as nurofen and voltaren will also help to decrease inflammation and provide temporary relief.

–          Orthotics: Heel pain is often caused by an incorrect walking pattern (over-pronation), and orthotic insoles will help to support the arches and re-align the feet. In most cases, an inexpensive orthotic insole from the pharmacy will suffice.

–          Correct footwear: Wear shoes that fit properly, have shock-absorbent (well-cushioned) soles, good arch support, and supportive heels.

The above measures will help to resolve most cases of heel pain within 3 months, although some cases may take up to a year.

Written by Caryn Viljoen

Senior Foot Care Podiatrist

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