Body Wise*

*The information contained herein is not intended to diagnose or treat ANY medical condition.

Heel Pain - Plantar Fasciosis

By Ray McClanahan

It is a pain in your heel. A constant morning reminder that it hurts to stand on your foot. For most walkers, the pain goes away after a few minutes of walking on their foot. For some, unfortunately, the pain persists throughout the day, causing them to walk in a compensated manner or limp.

The pain can be severe and affects a surprisingly large number of Americans. It is reportedly the most common foot problem presented to podiatry offices nationwide.

Previously thought to be an inflammatory problem of the plantar fascia ligament, which spans from the heel bone to the toes, it was called plantar fasciitis. It is known to be extremely difficult to get relief from, once it becomes chronic.

A recent research study examined surgical samples of plantar fascial ligaments from patients suffering from chronic heel pain. No inflammed tissue was seen under the microscope. Dead (fasciotic) tissue was seen in all of the specimens.

These study findings have prompted a name change for this painful condition to plantar fasciosis. Fasciotic tissue builds up at sites of chronic trauma, and at sites where blood is not pumping in and out of a body part effectively. In this case, the base of the heel.

Whenever a walker puts on a shoe, for work or for walking, they unknowingly put their great toe, and the rest of their toes, in a position that constantly pulls on all of the tissues that attach to the inside and bottom of the heel bone. By having their toes tapered, instead of spread, and toesprung, instead of on the ground surface, they are never capable of flexing their toes and allowing for a relaxation of the arch muscles, and a pumping out of the blood in that part of their foot.

Many walkers will compensate for these bad positions for years, while others will eventually develop plantar fasciosis, or another foot problem.

This is why flat shoes are necessary to prevent this problem from occurring. Shoes that allow the toes to be spread also prevent this problem from occurring. The soles of footwear should also be flexible enough to allow your toes and arch muscles to flex. Unfortunately, most walking footwear is rigid, as that has been the recent recommendation.

Racing flats have worked well for many walkers to achieve a more natural foot position, however the toebox has been too narrow for others to spread their toes.

Not all heel pain is plantar fasciosis, and caused by footwear.  There are many other known causes that closely mimic plantar fasciosis. This is why you should see a holistic footcare practioner for prevention and footwear education, as well as your regular footcare provider, for imaging, treatment, etc.

You should also try other treatments that increase local blood flow, such as contrast bathing, massage, rolfing, yoga, acupuncture, ART, graston, ultrasound, etc.

Be aware that when you transition to flatter footwear, your arch muscles will get tired and crampy, just like any other part of your body that you are developing will, for a period of time. Unfortunately, when arch symptoms increase this time of year, with more sandals and flip flops, the blame is placed on the footwear, instead of where it belongs. It should be blamed on the improper transition to that type of footwear, and the rapid increases in walking activity.

So go slow. Go barefoot. Work those arches. And, do not forget to spread your toes. Healthy walking!

Ray McClanahan, DPM, is a podiatrist and owner of Northwest Foot and Ankle Clinic. He is passionate about preventive foot care for walkers, hikers, and runners. McClanahan can be reached at 503-243-2699 or visit www.nwfootankle.com.