FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

ACTIVE PEOPLE SHOULD BE AWARE THAT “TIME WOUNDS ALL HEELS”

Question: I would like to know exactly what plantar fasciitis is.  I walk about an hour each day, and the soles of my feet are very sore (not while I’m walking but after I sit down).  My doctor tells me this is what I have.  Do I need to stop walking for this to heal?

Answer: First, let me say that from your description of where it hurts, it’s possible that you might have another foot disorder. Plantar fasciitis usually produces heel pain rather than pain on the sole of the foot. For the purposes of this column, however, I’ll assume that your diagnosis is correct and focus my remarks on plantar fasciitis.

Though plantar fasciitis is more common in those who work on their feet, the name has nothing to do with planting too many tomatoes in your garden. A little grammatical dissection is in order. “Plantar” is just a fancy word meaning sole of the foot, and “fascia” is a layer of connective tissue just below the skin. Therefore, the plantar fascia is a band of this connective tissue that extends from the base of the toes to the “front” of the heel bone. It also supports the arch of the foot and is vital to normal walking. When “itis” is added to a word it means inflammation, in this case of the fascia.

Plantar fasciitis is actually the most common cause of heel pain. It’s usually a dull, aching type of pain, and there can be complaints of stiffness in the feet as well. Frequently plantar fasciitis occurs in both feet. The first steps in the morning are often the most painful or the first steps when starting to run or exercise. Prolonged standing on a hard surface can also make your heel pain worse. Generally people with plantar fasciitis do not have foot pain during the night.

Damage to the fascia from sports activities is a common cause of plantar fasciitis. Also, it is more common in middle-aged and older people as the foot muscles weaken with age. While it’s a little bit of an exaggeration, you could say that “time wounds all heels.”

Other risk factors for this condition include being overweight, having flat feet or high arches, wearing shoes with inadequate arch support or stiff soles, being pregnant, or as I mentioned earlier, having a job where you work long hours on your feet.

Once you have been diagnosed with plantar fasciitis, appropriate treatment can be instituted. If you run or are active in sports, you should cut back on those activities that make your feet hurt. Some people do ice massages on the painful heel area, as well as using over-the-counter pain relievers.

Stretching the lower leg and foot can provide some relief. Also picking up marbles with your toes can help to strengthen the muscles of the foot. Multiple repetitions of raising and lowering the toes while keeping the heel on the ground is another way to strengthen the foot.

Custom heel inserts in the shoe may help and wearing a properly fitted shoe for athletic activities may prevent worsening or recurrence of the heel pain. Some people have cortisone injections in the heel to relieve the pain.

If you have tried all of this and your primary care physician isn’t sure of what do next, go see a podiatrist. A podiatrist is a health practitioner who specializes in problems of the foot and lower leg.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.