The Intolerable Heel Ache
“When I wake up my feet hurt. I can’t tolerate the pain arising from the ball of my foot when I get up from the bed. The first few steps are impossible to take. I walk awkwardly for some time and there is this tendency to fall as well.”
These are the exact confessions I hear from most patients who have the common condition named Plantar Fasciitis. This condition involves the heel and there is a swelling of a structure at the ball of your foot. There is a very strong band named plantar facia which connects itself to a bone called the calcaneus. This band is similar to a rubber band and has elastic properties. If you have a proper look at the bottom of your feet right now, the structure is similar to an arched bridge from front to back. To maintain the arch, this elastic band called plantar fascia works full time. A massive force runs through this band when we stand and bear weight.
There are many reasons why people develop this condition. It could be a minute injury at the junction between the plantar fascia and bone. The injury could be due to repetitive stress. Imagine a professional sprinter or a fast bowler performing their sporting manoeuvres. At the start of a 100m event, within a fraction of a second the athlete is expected to leap forward several meters. That entire stress/tension of several kilograms goes through his plantar fascia band. The same thing happens when a fast bowler is at the end of the crease putting massive force to his foot.
Other than sports injuries, there is a condition called enthesitis which gives rise to similar symptoms. At the onset of enthesitis, the plantar fascia swells up. The exact triggering factor is unknown. This can affect both heels and is sometimes associated with pain in the back of the heel. The back of the heel has a large band called the achilles tendon. Both these structures can swell up at the same time because of a condition called inflammation. Strangely this is associated with joint problems like arthritis in a certain category of people.
In most patients plantar fasciitis is a harmless self limiting condition, which settles on its own. What we do as specialists is to speed up the process of healing. Also there are very useful remedies that can ease the symptoms of plantar fasciitis.
How is it evaluated?
When you consult a joint specialist, he will first of all examine the region affected. The painful areas will be gently pressed and the ankle will be moved to determine which movement elicits pain. The intact side will also be examined. Don’t forget to mention about other areas that hurt as well.
Then certain investigations are recommended that includes blood tests like ESR and a full blood count. These are useful to determine the exact cause of plantar fasciitis. Sometimes an X ray is ordered to see whether a “Calcaneal Spur” is visible. This is a bony protuberance/tip that might cause pain when pressed against the skin of the heel.
There are very effective stretching exercises that specialist might teach you. These remodel the plantar fascia band and prevent further bouts of pain.
To ease off the pain a category of drugs called “Non Steroid Anti Inflammatory Drugs” are used. These will settle the swelling and slowly sort out the symptoms. There are other types of drugs like steroids to treat more intense pain. Sometimes steroids are injected to the heel to provide rapid relief.
A type of soundwave called Ultrasound therapy is used to create a soothing effect over the heel. Ultrasound waves cause the plantar fascia to vibrate slightly and the end result is the generation of heat inside. This heat heals the plantar fasciitis.
Infra red therapy is another method to temporary provide relief. The same mechanism of thermal energy is used as treatment.
There are splints that can be worn over the foot throughout the night. This might keep the plantar fascia stretched and prevent the excruciatingly painful first steps when you wake up.