How to help a heel that hurts

About five months ago I noticed a bruised feeling in the heel of my left foot when I got up. I didn't think much about it until the pain became intense.

I had studied plantar fasciitis (PLAN-tur fas-e-I-tis) in the Care and Prevention of Athletic Injuries class taught by Tim Johnson at Lake Tahoe Community College. Most commonly heel pain is caused by inflammation of the plantar fascia - the tissue along the bottom of the foot that connects the heel bone to the toes.



Signs and Symptoms

Sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot, is common. If heel pain tends to be worse with the first few steps after waking up, when climbing stairs or when standing on tiptoe it could be the plantar tendon.

Heel pain after long periods of standing or after getting up from a seated position, as well as after (not during) exercise are other indicators.

Swelling may also occur in the heel.



Causes

Plantar fascia is a shock-absorber protecting the arch in the foot. If the tension becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed. The causes of plantar fasciitis can be physical activity overload.

I have more pain the morning after a good kickboxing class. Plantar fasciitis is common in long distance runners. Jogging, walking or stair climbing also can place too much stress on the heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen. Even household exertion such as moving furniture or large appliances can trigger the pain.

Some types of arthritis can cause inflammation in the tendons in the bottom of the foot which may lead to plantar fasciitis.

Although doctors don't know why, plantar fasciitis occurs more often in people with diabetes.

Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed.

Thin-soled shoes or ones that are loose, lack arch support or the ability to absorb shock don't protect your feet. If you regularly wear high heels, your Achilles tendon - which is attached to your heel - can contract and shorten, causing strain on the tissue around your heel.



Self-care

Hold a cloth-covered ice pack over the area of pain for 15 to 20 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation.

Stay off your feet for several days when the pain is severe.

You probably won't have to permanently retire your running or walking shoes, but it's a good idea to cover shorter distances until pain subsides.

Swap walking or jogging for swimming or bicycling. You'll likely be able to return to your regular activities as heel pain gradually improves or disappears. However, some people find that the only way to avoid a recurring problem is to permanently modify their aerobic activities.

Inexpensive over-the-counter arch supports take the tension off the plantar fascia and help absorb shock.

Apply pressure to your heel by rolling a golf ball or tennis ball with the arch of your foot while you are standing and stabilized. This can help reduce pain and increase blood flow.

Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others), naproxen (Aleve) and others may ease pain and inflammation, although they won't treat the underlying problem. Use as directed, tapering off as your pain decreases.

Simple exercises using household objects can stretch or strengthen your plantar fascia, Achilles tendon and calf muscles.

If self-care doesn't help, then contact a professional. (I received acupuncture treatments from Scott Nanamura with amazing results).



Prevention

Maintain a healthy weight. This minimizes the stress on your plantar fascia.

Choose supportive shoes. Give stilettos the boot. Also avoid shoes with excessively low heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don't go barefoot, especially on hard surfaces.

Don't wear worn-out athletic shoes. Replace shoes before they stop supporting and cushioning your feet. If you're a runner, buy new shoes after about 400 miles.

Start sports activities slowly. Warm up before starting any athletic activity or sport, and start any new exercise program slowly.

Wake up with a stretch. Before you get out of bed in the morning, stretch your calf muscles, arch and Achilles tendon by reaching for your toes and gently flexing your foot. This helps reverse the tightening of the plantar fascia that occurs overnight.

There is nothing better than being physically fit so do not let injury stop you from being active. You can change or modify the activities you enjoy the most.

Fall quarter kickboxing anyone?

- Rhonda Beckham is a nationally certified personal trainer, with teaching certificates in Pilates and kickboxing. She is owner of Help Me Rhonda and Perfect Pilates, a Pilates instructor at Lake Tahoe Community College and Sierra Athletic Club, as well as a personal trainer operating out of Sierra Athletic Club and the Tahoe Keys Marina Dance Studio. She may be reached at (530) 208-6369, www.tahoetrainer.com and rhonda@tahoetrainer.com.



Risk factors

The risk of developing plantar fasciitis increases if you are:

Active in sports

Flat-footed or have high arches

Middle age or older

Overweight

Pregnant

On your feet a lot

Wear shoes with poor arch support or stiff soles