Heel Pain Myths and Truths
Two of the largest myths for the cause of heel pain are weight and bone spurs. Although both may contribute to heel pain, there is no correlation that they are the primary cause. Most heel pain is caused by an abnormality of the plantar fascia. Plantar fascia is the structure, which separates the fatty (sub cutaneous) layer from the muscle layer of the foot. Plantar fascia originates from the heel and attaches to the toe (metatarsal phalangeal joint) joints. Plantar fasciitis occurs when there is damage to this structure at its origin on the bottom of the heel. There is lots of speculation why this occurs, but no universal agreement to cause.
Myth #1: Being overweight causes plantar fasciitis.
Truth: Not all overweight individuals have plantar fasciitis
Myth #2: Spurs cause planar fasciitis.
Truth: Many individuals have heel spurs (calcification of the plantar fascia) but never had heel pain. People have X-rays, which show spurs, yet they have never had any heel pain. X-rays are useful for ruling out other causes of heel pain, which is necessary when being evaluated. Sonograms are a more informative tool in identifying plantar fasciitis.
Plantar fasciitis symptoms are pain in the morning on rising and after rest. There is pain when getting out of bed or after sitting. Initially it will be only a few steps then go away. Think of the abnormal tissue having fluid within it where it is attached to the bone. The nerves that transmit pain are on the tissue attached to the bone. There is an increase in fluid accumulating around the tissue attachment during sleep and periods of rest, which gets displaced when standing. Just as an injection into tissue displaces structures and causes pain, a similar condition is occurring in the heel on rising. Imagine a sponge filled with water. Squeeze the sponge a few times and the water is gone. When rising after rest, fluid excess is squeezed away initially causing pain then becomes less. When immobility occurs, it is given a chance to build up again.
Plantar fasciitis treatments are numerous. Generic foot inserts, gel inserts, hard inserts, custom inserts, injections, stretching, night splints, ect, ect. Truth is most fasciitis if caught early can be treated with a decent running shoe which limits motion (pronation) in the foot The foot and ligaments are under greater strain when the foot is maximally flat (pronated- foot turned out from leg) and under less strain when higher arched (supinated- foot turned inward or under leg).
Myth #3: Night splints are stretching the plantar fascia.
Truth: Night splints hold tension on the plantar fascia not allowing fluid to accumulate. It correlates to trying to pour more water into a sponge while squeezing the sponge. Less fluid in the tissue will correlate to less pain on rising.
Myth #4: All foot inserts are work the same.
Truth: A Chevy Aveo and a Ferrari will get you from point a to b. Both are cars but the Ferrari will get you there faster. Foot orthotics turn the foot inward and more under the leg (supination). This rests the foot allowing the injured tissue to rest and heal. The more rigid and custom orthotics tend to reduce outward rotation of the foot (pronation) better than softer inserts. This correlates to a greater probability to help heal fasciitis. Raising the heel height of the shoe does the same thing. Increased height increases inward rotation of the foot resulting in less tension to the fascia. Decreased height increases outward rotation of the foot on the leg causing increased tension on the fascia. Don't wear flats and sandals.
Myth #5: I need more cushion under my heel.
Truth: Plantar fasciitis is a mechanical sprain. There is no correlation to loss of padding, thus inserts made to add cushion to the heel generally do not work.
Myth #6: No treatment is needed because heel pain resolves on it own.
Truth: Plantar fasciitis will go away without treatment when it becomes so painful people limit all activity, resting the tissue sufficiently to allow healing. This normally takes 18 months, which is not ideal. Plantar fasciitis can be treated while allowing normal activity levels of work and play. The most frequent mistakes people make is not maintaining the foot rested. Periods of walking wthout proper bracing (orthosis/ running shoes) allow the injury to continue. It would be the same if you tore a biceps tendon, placed the arm in a sling the entire day then at night took the sling off, went shopping, lifting groceries ect., place the arm back in a sling and wonder why it is not getting better. Stabilization/splinting should be from the time out of bed to bedtime.
Any pain, which is not alleviated within a reasonable period of time, should be evaluated. Most soft tissue injuries resolved in 3-6 weeks. Pain beyond this needs to be thoroughly evaluated. Nerve entrapment, arthritis, bone cancer, stress fractures, infections, any many other things can cause heel pain. It is not prudent to pretend all heel pain is plantar fasciitis. Seek medical advice for severe debilitating pain, or pain getting worse.