“My Heel Kills Me When I First Get Up”
Heel pain is a real nuisance. You can’t run, you can’t jump, it hurts to stand up from a chair, and when you get out of bed, it “kills” you! But after you walk for awhile, it eases up. The pain goes away until you stop and sit down. When you get up it starts all over again. What a pain! If you’ve ever had heel pain you know what I’m talking about. The first time I had it was playing basketball in high school wearing Converse All-Star shoes with thin soles and no arch support. I limped in pain after practice, but I guess because I was young it went away.
Unfortunately, it returned when I was in my fifties. This time it was unrelenting. I was running regularly on paved county roads in bad shoes again. The episode in one heel lasted one year, and in the other heel, it lasted fifteen months. For over two years I was very badly affected by heel pain. I was unable to do many of the things I enjoyed doing. It hurt so badly I was worried I would be unable to escape a fire if there were one.
I really don’t remember any lectures about heel pain in medical school nor was there any rotation with a foot specialist (Podiatrist) during my residency. The Orthopedic Surgery Department would have been the deliverers of that Information, but they acted like people didn’t have feet. They were focused on fracture care, back surgery, knee reconstruction, and later, joint replacement. I learned more about heel pain from having it than any lecture or seminar could have taught me. My diagnosis was Plantar Fasciitis. You may have had it, too, because a lot of people do. In fact, ten percent of the general population has heel pain accounting for one million patient visits per year to doctor’s offices. Plantar fasciitis (PF) is the most common problem seen by podiatrists, so they are the experts in treating it. The incidence of PF increases with age (83% of cases are age 25-65), men have it more often than women, and athletes, especially runners are very susceptible. Between 4% and 22% of all runners experience it.
The plantar fascia is the ligamentous structure that holds the arch of the foot together. It’s like the bowstring on a bow (like in bow and arrow) extending from the heel to the toes. The arch has a springy effect which allows flexibility in the foot. That flexibility is limited by the plantar fascia. If there is repeated forceful stretching of the plantar fascia from running, jumping, and overuse of any kind, micro tears develop in the fascia at its attachment to the calcaneous (heel bone). These tears become inflamed and cause the pain we experience. Some investigators have shown these tears to be degeneration of the collagen within the fascia. They say “plantar fasciosis” is a more appropriate name. But whatever the situation, the result is pain which is very troublesome.
Patients with PF are frequently obese, have flat feet, high arches, and tight calf muscles, and on x-ray have heel spurs. Ten to 20% of the general population have heel spurs, but only 5% of those patients have heel pain. Heel spurs are NOT the cause of heel pain. Lots of people have painless heel spurs but evidence shows it’s not the spur that’s causing the pain. “Surgically removing a heel spur does not necessarily relieve the pain.
Symptoms are as mentioned above. Patients have pain in the heel upon arising from bed or after sitting in a chair for awhile. As they walk, the pain eases (mine never did). There is tenderness of the bottom of the foot, just in front of the heel bone that worsens when the foot is flexed. It feels like you’re walking on a piece of iron attached to the bottom of your heel.
All sorts of treatments are used to relieve it, but 90% of cases resolve on their own in ten months. My first episode lasted a year and the other fifteen months. Rest, ice packs, heel and Achilles stretching exercises, anti-inflammatory medications, soft supportive shoes with orthotic inserts, and cortisone shots (three times in each heel) were tried. Finally, after a year of misery, the pain went away gradually. The second episode occurred a year later, and in addition to those treatments, I wore a splint at night in bed that stretched the plantar fascia by holding my ankle flexed with my toes heading upward. Every night from November to March I faithfully wore that splint, and eventually my heel improved. Surgery was my last option (endoscopic plantar fascia release), but outcomes from that don’t always meet patients’ expectations.
Of course, other things can cause heel pain, too, such as Rheumatoid Arthritis, Achilles tendinitis, Achilles’ tendon rupture, bursitis, osteomyelitis, Paget’s disease, peripheral neuropathy, sarcoidosis, and fracture, but Plantar Fasciitis is still the most prevalent diagnosis.
Since then I’ve had no further episodes of PF and my feet still pronate (are flat), and I still have bone spurs on each heel. BUT I NEVER FAIL to wear the orthotic shoe inserts my podiatrist made for me, any time I do anything. I never go barefoot and wear shoes everywhere. One episode of Plantar Fasciitis in a lifetime is enough, and if you’ve had it you know what I’m talking about.
References:
- painscience.com/tutorials/plantar-Fasciitis
- mayoclinic.org/diseases-conditions/plantar-Fasciitis
- American Family Physician Vol.63, Number 3, February 1, 2001
- Orthoinfo.aaos.org/en/diseases—conditions/plantar-Fasciitis-and-bone-spurs
- lermagazine.com/article/the-epidemiology-of-plantar-Fasciitis
- American Academy of Podiatric Sports Medicine: “Plantar Fasciitis: Treatment Pearls” by Douglas Ritchie Jr, DPM.
