A Guide To Conservative Care For Heel Pain

Christopher Corwin, DPM

More often than not, patients with plantar fasciitis have already attempted to resolve the condition on their own before they come into your office. This author explores a range of effective conservative treatments, investigates the potential of physical therapy and offers pointers on getting patients to stretch in the appropriate manner to help relieve plantar fasciitis.

Plantar fasciitis is one of the most common ailments affecting the feet. Millions of Americans suffer with heel pain on a daily basis. It affects people of all ages, races and activity levels. This includes professional athletes, weekend warriors and average Joes. Teachers, nurses, mechanics, retail salespeople and anyone who has suffered pain in the plantar aspect of the heel can attest to its debilitating nature. Heel pain can adversely affect a person’s quality of life. It can also affect one’s work and decrease productivity.

   By the time plantar fasciitis patients have walked into your office, many of them have already received a multitude of diagnoses from friends, co-workers and the Internet. They often tell you that they have a “heel spur, plantar fasciitis, that fascia thing or the plantar.” (I do not know where this one came from but I grow weary of having to explain that plantar is not a diagnosis and only means the bottom of the foot.) Many have already attempted to use cushioned insoles in their shoes from “the scanner at Wal-Mart,” ice, nonsteroidal anti-inflammatory drugs (NSAIDs) and some may have gotten new shoes.

   A careful history can often provide insight into the cause of the problem. When did the heel pain start? Was it a few weeks into a new exercise program, after buying a new pair of shoes or upon returning from a beach vacation with frequent walks on the beach? Usually, patients can trace the start to some change in a routine. These changes can include moving from a desk job to one that requires more time on one’s feet, starting an exercise program, switching shoes or wearing old shoes that have broken down. This may also include stopping shoes altogether as we have seen with the most recent reincarnation of the barefoot running fad or quickly transitioning to a minimalist style running shoe without an appropriate progression.

   We tend to see a large spike in plantar fasciitis as the spring rolls into summer and people move from slightly more supportive “winter” shoes to flip-flops and flatter shoes. (However, this spike has been slightly negated over the past few years as more people are being affected with plantar fasciitis through the winter due in large part to flip-flops becoming year-round fashion as well as the emergence of non-supportive fleece lined boots becoming a prominent fashion phenomenon.) The return of summer also means a large number of people cutting their grass in old, broken down sneakers that they would not run in anymore but feel obliged to wear while pushing a lawn mower on an uneven surface.

   Also look at the patient’s medical history for any recent surgeries such as unilateral total hip or total knee replacements. These surgeries may cause a limb length discrepancy or increased stress on a particular foot due to compensation. Ask about other joint involvement. Is there a systemic reason for the pain such as any of the inflammatory arthropathies? Recent weight gain causes increased mechanical load on the foot but it also may be a marker of a thyroid issue, which can also lead to heel pain. Look for new medications or changes in medical history that occur at the time of the onset of the heel pain or just prior. These can all provide significant clues to the reasons behind the heel pain. If you do not address these reasons, this will doom many of the treatments to failure or only short-term relief.

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