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ASK THE DOCTOR: Stretching can reduce heel pain
By Dr. JIM MITTERANDO
The Patriot Ledger

heel strechingQ. What can I do about my persistent heel pain? It hurts when I first get moving and then gets better after I have walked a while. I have had it for months and can’t seem to get rid of it.

A. The most common cause of heel pain - plantar fasciitis - is an irritation of the ligament (plantar fascia) along the bottom of your foot that connects your heel bone to your toes. The plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. However, if tension on that bowstring becomes too great, minute tears and inflammation occur where it connects to the heel bone. The result is a stabbing or burning heel pain that’s usually worse in the morning because the fascia tightens overnight. Once your foot and calf limber up, the pain generally decreases, but it may return after long periods of standing or after getting up from a seated position. In severe instances, your heel may hurt with the slightest pressure, making walking difficult. Sometimes, plantar fasciitis is also associated with a bony growth (heel spur) that develops from tension on your heel bone. The spur is not the problem, as is commonly thought, but is a sign of tight fascia.

Without treatment, plantar fasciitis will often resolve over six to 18 months. With treatment, it can improve in two months.

Stretching is essential to treat the tightness of the plantar fascia, Achilles tendon and calf muscles. The ‘‘runner’s stretch’’ involves leaning against the wall and stepping forward leaving the back foot flat on the floor. The ‘‘stair stretch’’ requires standing on the edge of a step and dropping your heels while holding on to the banister. It is important to hold these stretches for at least 30 seconds.

Other exercises of the foot include:

  • Rolling the arch of your foot back and forth over a can or tennis ball on the floor
  • Picking up marbles, coins or a towel with your toes
  • To decrease the stress on the plantar fascia you may need to:
  • Wear shoes with more arch support
  • Avoid high heels
  • Shed unwanted pounds to take pressure off your feet
  • Buy new shoes; worn shoes may not provide enough support
  • Stretch before and after exercise

Athletes and active people may need to spend less time doing actions that cause foot stress, such as walking, jogging or jumping, and try alternative exercises like bicycling or swimming until the heel pain resolves. Sometimes, simply reducing the distance you walk or run can make quite a difference after several weeks.

If your heel pain does not improve with these measures, you may need an arch support to reduce strain on the plantar fascia. Try over-the-counter arch supports, which cost around $20. If these do not work you can have custom orthotics made to insert into your shoe. Soft orthotics cost around $120 and last 2 years. Rigid orthotics cost around $350 and last 5 to 10 years.

Don’t bother with cushioned heel pads or heel cups; they are not as helpful in treating the heel pain of plantar fasciitis.

If orthotics do not help, your doctor or podiatrist can make night splints that stretch the foot and calf while you sleep.

If symptoms persist, your doctor or podiatrist may try a cortisone injection. Injections are pretty effective but have the potential risk of weakening the plantar fascia which could lead to a rupture of the fascia.

New shock-wave therapy has been popular recently. It does not seem to be anymore effective than other measures mentioned though it can help some people for whom all else has failed. It is not covered by most insurance companies and costs around $600. In extreme situations, surgery is used to release tension on the fascia but this involves a lengthy recovery, use of crutches and possible loss of the arch of the foot.

Ice and anti-inflammatory medications (ibuprofen, naproxen) can be useful during the first several months of pain when inflammation plays a role. Resting your foot on a bag of frozen vegetables can be quite soothing. These treatments, though, are not as helpful for more chronic heel problems.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2003 The Patriot Ledger
Transmitted Tuesday, August 12, 2003