Ouch, What is Wrong with my Foot?
Ouch. This has happened to me and to several of my friends and family. You wake up in the morning, get out of bed and it hurts to walk. It feels like something is stabbing you in the heel of your foot or you stepped on a stone. Your symptoms seem to improve after you walk around for awhile. The problem may go away after a day or two, but it may come back and the pain is increased after standing for awhile. You check the bottom of your foot and do not see any signs of injury, calluses or warts. However, when you touch your heel firmly, it hurts. What is going on?????
If these symptoms happen to you: pain on the bottom of your foot, worse in the morning with increased pressure and improved after walking during the day, you may have plantar fasciitis and or a heel spur. On the bottom of our feet is a long tendon that starts at the “heel bone” and then goes to each support toe. This tendon is called the plantar fascia. This tendon is important as it acts as a “shock absorber” and supports the foot when you put pressure and or weight upon it. The plantar fascia is also responsible for creating the long arch of the foot. A heel spur is a bony growth that looks like a small curved spike at the base of the heel on xray. The heel spur irritates the plantar fascia and causes inflammation, tiny tears and pain. What is interesting is that just because you have a plantar fasciitis, does not mean you have a heel spur. Paradoxically, just because you have a heel spur, does not mean you will get plantar fasciitis either. Other risk factors for plantar fasciitis are increased weight; improperly fitting shoes; and weak or “tight” calf muscles.
On physical exam, you can feel a tender spot on the bottom of your foot. The pain will get worse when you flex your foot and push on the plantar fascia. The pain gets better when you point your toes downward. X rays do not help determine the diagnosis; although an x ray may show a heel spur or a possible heel fracture.
Treating plantar fasciitis is pretty routine and can be done by yourself. “RICE it”
R: Rest your foot for a few days. Don’t put your full weight on the foot.
I: ICE it. Put a water bottle in the freezer. Put it on the floor and roll your foot from heel to toe on the frozen water bottle. Do this no more than 20 minutes at a time.
C: Cool down the inflammation with an anti-inflammatory medication such as ibuprofen or naproxen.
E: Exercise. Calf stretch: a) lean against the wall with your hands. Keep one leg in front with the knee bent and one straight with your heel against the ground; b) Stretch your calf muscle leaning forward with your hips; c) hold for 10-20 seconds. Repeat. Towel stretching. a) Wrap a towel around the base of your foot and hold onto both ends of the towel; b) Pull on the towel to give a comfortable stretch; c) hold for 10-20 seconds. Repeat
Plantar fasciitis will usually resolve within six to eight months after proper stretching and supportive care. If not, other options include corticosteroid injections into the fascia; proper fitting heel inserts or heel cups for your shoes or night splints. Night splints keep the foot flexed and pointing upwards. Most persons sleep with the foot pointing downward, which can exacerbate the fasciitis. Also, be careful about corticosteroid injections. Injections may provide relief by reducing inflammation; however, there is the risk of weakening the fascia or causing the natural fat pad in our heel to atrophy. Either of these side effects can increase the problem and the pain.
1. Make sure that your shoes fit properly; have proper cushioning and that your shoes support your heel and arch of your foot.
2. Avoid walking barefoot on hard surfaces like sidewalks.
3. Stretch and exercise your calf and muscles of the foot. You can do simple calf exercises and stretches like the one written above. You can also sitting and alternate between elevating your foot and keeping the heel on the ground and elevating your heel and keeping the ball of the foot on the ground. Another exercise simple exercise is to pick up coins or marbles with your toes. Last, if your symptoms increase or differ from the ones that I have described, please go see a health care provider. You may have another foot problem: a stress fracture, a neuropathy or some other pathology.