Hey there, time traveller!
This article was published 15/1/2016 (463 days ago), so information in it may no longer be current.
If you find your first steps in the morning feel like a hot poker in the bottom of your heel, you may be suffering from plantar fasciitis.
This overuse condition affects many people and is not usually related to a specific injury or trauma to the foot. More often, it comes on gradually and is related to a change in activity pattern.
The plantar fascia is a connective tissue on the bottom of the foot that gives structural support to the arch. Though your plantar fascia can adapt to new loads and activities, too much of something new too fast can create irritation as the tissue reacts to abrupt change.
Changing your exercise habits, with more distance running or walking, is a common culprit. Sometimes the trigger is more subtle, such as a change in footwear or a new job with more time on your feet on a hard surface.
Those dealing with plantar fasciitis will complain of pain on the bottom of their heel in the morning with their first steps out of bed. The pain often eases with a little bit of walking, but worsens with extended periods on their feet. The heel pain often appears after getting up from sitting for a while.
In response to these symptoms, people often try to wear shoes that are soft and flexible. That's not always a good idea. The load that leads to pain and injury of the plantar fascia is a repetitive stretching or tension on the tissue where it attaches to the heel bone. Flexible shoes can often increase this load by allowing your feet too much movement.
The key is to provide the tissues of your arch more support as well as some gentle cushion for your heel for comfort.
This support can be accomplished a number of ways, but one of the most practical solutions is to change your footwear with a focus on better structure. The most supportive footwear is often active and athletic. A good running or walking shoe offers a blend of support and cushion that can make it easier to be on your feet longer and help your symptoms settle.
Not all running shoes are created equal. Some are built with the intention of more support for the joints and soft tissues of the foot, while others are built to encourage movement and mimic walking or running in bare feet. There are arguments for both designs. If you have a foot that is already sore, a more supportive shoe is appropriate, at least in the short term until symptoms have resolved.
What makes a running or active shoe more supportive? Looking underneath at the sole of the shoe, a more supportive model is usually a little straighter in shape. It is also is stiffer and not easily bent or twisted. The back of the shoe is re-enforced with a component called a heel counter that limits rock and roll movements of the heel. Testing the shoe with a twist and bend of the sole and a squeeze of the back of the heel are quick ways to compare footwear.
Shoes that have laces and an upper (the fabric top portion of the shoe) that is not overly soft and stretchy are going to provide additional control. Shoes with removable insoles provide more room and the option of using an over-the-counter insert or a custom foot orthotic to add more support. No one single shoe is best for everybody. When looking for the correct fit, a knowledgeable salesperson is essential.
Remember, a good shoe is only helpful if you are wearing it. You can think of supportive footwear in a similar way to a cast or brace used after a fracture or sprain. Using them for a period of time gives the plantar fascia some rest and a chance to heal.
Avoiding bare feet in the house can make a big difference in your heel pain. The first option is to wear active footwear in the house. For those who like their feet to breathe a bit, an alternative in the house can be a supportive sandal rather than a flexible slipper.
There are many other options to treat heel pain. These include but are not limited to: stretching, ice, physiotherapy, night splints, medication and custom or over-the-counter orthotics.
If you are having heel pain, start by treating your feet to more supportive footwear.
Consult your doctor, physiotherapist or other health-care practitioner for assessment and treatment guidance. Remember to bring in the shoes you wear to have them evaluated as well.
Mark Beatty is a physiotherapist practising at Foundation Rehabilitation Services at the Pan Am Clinic.