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Heal the heel.

What is it? How to solve it.

Does this symptom sound familiar to you? Excruciating pain in the heel that is worse in the morning or after long periods of rest that feels much better after icing or stretching of the foot.

Yes?  Then you have plantar fasciitis.

The plantar fascia is the ligament on the bottom of the foot which connects your calcaneus (heel bone) to the metatarsals (toes).  It acts as the support for your arch, and undergoes tension as the sole weight bearer to your body. In younger patients, the plantar fascia may be connected to the achilles tendon at the heel bone insertion and therefore be one more involved. 

No one is immune to the possibility of getting plantar fasciitis. It can affect someone who is flat footed, as well as someone with a very high arch. Patients who are overweight might be impacted because of the strain and pressure put on the bottom of the foot. Patients with occupations that have them standing for long periods of time, like restaurant staff or teachers can cause the onset of this problem. And, lastly wearing shoes that are ill-fitting, or worn out with no support will also cause the beginnings of heel pain. 

Plantar fasciitis and plantar fascial tears have been in the news a lot because professional athletes such as Peyton Manning, Drew Brees, and Damian Lillard suffering from variations of the injury. Unfortunately it is something that is very painful, and can become debilitating. At times, pro athletes have to take weeks off to allow the fascia to fully heal, before returning to their high impact activities. 

There are a wide range of treatments for plantar fasciitis. At anytime you can google search for this pathology and find hundreds of braces, pads, socks, and even shoes that guarantee to be the cure for your symptoms. This causes a lot of confusion and frustration for patients because you never know what really works.

Many times doctors will start out by treating their patients with conservative therapies, such as icing and stretching. Icing the area helps because it will help reduce the inflammation at the heel which in turn will lessen the pain. (Many times patients will use heat, thinking it will help, but heat will actually worsen symptoms because it will increase the swelling.) Next, stretching the plantar fascia is key to increasing flexibility, as well as tensile strength of the plantar fascia. The more you stretch, the quicker most symptoms will be relieved. Patients are also recommended to take ibuprofen, or other natural anti-inflammatory like curcumin, for an allotted period of time, to help lessen the swelling and pain. 

Concurrent to the above treatment plan, it is essential for patients to wear the correct type of shoe that will give them the needed stability and support. This simply acts to reduce the strain on the plantar fascia allowing for the treatments to work.  Additionally, it is recommended that a patient invest in orthotics, as they are another way in which the foot structure maintains its stability.

If the symptoms continue to occur, a more aggressive approach will be taken by your doctor. The most common option is injecting cortisone in the area of the heel pain. This injection usually brings great relief in symptoms as it will decrease the swelling and inflammation immediately. The downside to this treatment is that if injections are given too frequently, the fascia can weaken and possibly rupture.

In worst case scenarios, none of the above treatments work and surgery may be recommended to release the plantar fascia. By releasing the plantar fascia, the constant strain on the ligament is eliminated, allowing for immediate relief.

If you think you might have plantar fasciitis, the best thing you can do for yourself is to make an appointment with your podiatrist to be evaluated and start the path toward recovery.

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