What can I say? In podiatry school, our professors told us that most of our future practices would be dedicated to helping patients who suffer with plantar fasciitis and that we would be treating heel pain every day of our careers. If I didn’t believe it then, after ten years in private practice (and a wicked case of heel pain for yours truly ten years ago) I certainly believe it now!
People like to say that they have a “heel spur” but in my experience it is usually not the actually heel spur that is causing pain. It is the inflammation and swelling of the soft tissue called plantar fascia as it inserts into the heel bone (the calcaneus) that causes the pain.
On a patient’s first visit, I always get an x-ray to rule out any possibility of a stress fracture or another underlying problem (bone tumor, ect). Many times, a patient will have a stress fracture and plantar fasciitis and, strangely enough, in my experience it is usually the stress fracture that heals first. I will also sometimes get an ultrasound to make sure there is no bursa which is a small fluid filled sack under the heel bone that can cause pain. Patients often have the sensation of “walking on a hard pebble” when there is a bursa present. More often than not, there is no bursa present and the pain typically is plantar fasciitis or an undiagnosed stress fracture.
Plantar Fasciitis typically presents with patients who complain of waking up in the morning and having severe pain when they first get out of bed but the pain gets better with more walking and this process repeats itself every time they get up after sitting down for any length of time. A Stress Fracture is usually a dull, constant ache that gets worse with more walking and hurts most at the end of the day. Patients often think that because the pain is not excruciating that it can’t be a fracture. In reality, fractures are usually more like a dull ache that just won’t go away -a toothache type of pain – it’s moderate but not terrible. One example, I had a patient who had chronic pain in her right foot for twenty years. We took an x-ray and it turned out that she had a chronic stress fracture of her second metarsal bone that she had been walking around on for years! After eight weeks of immobilization and rest, she was pain free. I always tell patients that if your foot hurts for more than three days – see a Podiatrist! You’d be surprised at the relatively simple non-surgical things we can do to ease your pain and get you on the path to healing.
I find that I can successfully treat heel pain ninety-nine percent of the time without surgery, using pain-free conservative modalities, proper shoegear and inserts.
I always advise my patients that the treatment of plantar fasciitis is a two-step process:
First, we must get them through the healing process.
Second, after they heal, we must get them into proper shoes and inserts so the problem does not return (and it will try to return!).
My Recommendations for Patients Suffering with Heel Pain:
*Go to a Podiatrist and get x-rays to confirm that you are not walking around on a stress fracture!
*Stop walking barefoot. The only time you should be barefoot and standing is in the shower. And yes, that is long-term!
*Stop wearing flip-flops.
*Do wear Croc Clogs (with the strap to the back) as your house shoe. As soon as you get out of bed in the morning, you should be stepping directly into your Croc Clogs.
Let me stop here for those of you who are horrified at the possibility of giving up your flip-flops – if you stop walking barefoot, stop wearing flip-flops and do wear Croc-Clog’s (with the strap to the back of the heel) around the house – you will have prettier feet, save money in medical bills, and have less pain in your feet, knees, hips and lower back and probably get a significant improvement in your heel pain over the next several weeks.
*Once again – go to a Podiatrist to get you through the healing phase. I won’t go into all the therapies/modalities at this time but will skip forward to that happy day when you are on the road to recovery and we shall concentrate on proper shoe gear and inserts…
*Croc Clogs around the house (with the strap to the back)
*For a good Walking shoe:
*MBT’s (with arch support – either a custom-molded orthotic or a good over-the-counter insert).
*Sketcher Shape-ups (with arch support)
*Spira Walking Shoe (with arch support)
*New Balance 927 (with arch support)
**Please see my reviews on all of these shoes on previous blogs that I have done. These shoes are not for everyone and can often be pathology specific. For instance, if you have Achilles Tendonitis, balance problems or certain neurological disorders, you do not want to get into the MBT or the Sketcher Shape-up.
**You can also refer to the “Podiatrist Recommended Shoe Store” at the top of this page for photos of these shoes and other recommended shoes.
For more information, please refer to my article on “Chronic Pain and Your Feet” which goes into more detail about the importance of shoes.
I hope this was helpful!!
Have a Wonderful Day…
Dr. Cathleen A. McCarthy