Healing for the Heel

If you are an avid runner or walker or have a job that requires a lot of walking or standing on hard surfaces, you may be at risk for plantar fasciitis(pronounced fashee-EYE-tiss). This condition gradually starts with mild pain at the heel bone and is most noticeable when taking your first few steps out of the bed in the morning, getting up from a chair after a long period of sitting and after exercising.

The American Academy of Orthopaedic Surgeons describes plantar fasciitis as an overuse injury which affects the sole or flexor surface (plantor) of the foot, which causes the inflammation of the tough fibrous band of tissue(fascia) connecting your heel bone to the base of your toes.

According to Mike Kelo, Owner of Mike Kelo Physical Therapy, some causes of plantar fasciitis are:

  • Foot type - someone inherits a shape of foot that is much more likely to have tension on the fascia.
  • People may inherit less dense fascia
  • Certain environmental lifestyle issues i.e. working on concrete floors, standing 8, 10 and 12 hours a day.
  • Running and walking

Kelo points out that a great way for people doing weight bearing exercise (i.e. running, walking) to assess the condition for themselves, is to periodically push into their fascia to see if there is any tenderness, if so they need to incorporate some measures to rid the discomfort to that area and prevent recurrence.

"The first hint of symptoms means you're not stretching the calves enough. Some people don't realize that the tightness in the calves may lead to calf strain or arch pain. A "calf stretch" or "windlass stretch" are two types of stretches that can help keep the tissues in the arch flexible," said Kelo.

Ideally he recommends 15 to 30 seconds holds when stretching and points out that stretching can fit anywhere in your lifestyle. "You can do these stretches in the kitchen, work environment or on the sofa-you don't have to get up and do anything special to incorporate stretching into your lifestyle.

All too often, Kelo said many people simply don't heed their aches and pains, believing it will resolve itself and wait months before seeking medical attention which he said can cause them to layer other components of the problem on more scar tissue and can force them to stop their exercise regimen completely.

While stretching is one way to ease heel pain caused by plantar fasciitis, another way is to self assess your footwear.

"Easing the pain can mean doing something as simple as changing your shoes or wearing the proper orthotic," Kelo said. "Generally the public has a difficult time getting into the right type of shoe. Shoe manufacturers offer such an excessive number of choices that it confuses the average consumer," he said.

"The key is to consult a knowledgeable foot professional when trying to determine the correct shoe type. 'Red Wing Shoes' offers options like a soft sneaker like bottom to a steel toe boot for state police and some manufacturing people."

Kelo suggests starting with a basic orthotic, such as the "Powerstep Orthotic" for someone who needs very little heel control but more of an arch support.

"The one size fit all, off the shelf, one shape made for millions of feet orthotic is not adequate for a lot of people," Often times Kelo has to modify and customize a basic orthotic to best suit the need of his patients.

There are various ways physical therapy can ease and alleviate heel pain caused by plantar fasciitis. Some of the methods used by Kelo include taping around the arch to support the foot, cortisone patch, changing or modyfying orthotics, having the patient wear a boot(non-weight bearing method), and in some cases suggest a patient wear a "Rocker-Bottom Shoe" if the plantar fascia has ruptured and can't be repaired.

"We try to incorporate these methods in a logical progression to fit with the patient's lifestyle, unless signs and symptoms are so dramatic that we have to move to something else. Surgery is the last option for a patient, because the outcome is not guaranteed."

Since there are a greater number of people engaged in foot and leg demanding activities, Kelo suggests walking and running on synthetic tracks. "It's best to use the outside lanes and do some clockwise and counter clockwise walking or running." He also recommends nature trails at local parks as a great venue for runners and walkers. Treadmills are also better than hard roads and warns against indoor tracks because while the material is okay, the angles he said can create problems for walkers or runners.

Keep in mind when outdoors, softer black top is always better than a concrete surface, adds Kelo.

"Sometimes simply changing the side of the road you walk or run on can be an easy solution for someone with this condition. We don't want someone always running against traffic, nor do we want them running with traffic. If someone has a right plantar fasciitis problem and runs against traffic, the drainage crown on the road can drive the right foot into much more pronation."

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