By Ray Fosterrlf@mt-rushmore.net


This is one of a number of Medical Checkpoints giving information about common conditions and what you can do about it. Your opinion and reaction to these Medical Checkpoints would be valued and appreciated. Medical Checkpoints are published periodically by NEWSTART Healthcare and are provided as a free service.



The medical name is "Plantar fasciitis". The plantar fascia is the strong band of tissue that runs between your heel bone and the base of your toes. "Itis" means inflammation which causes pain.


The following definition is by E. W. Paice, and B. I. Hoffbrand, from Whittington Hospital, London, as appeared in the British edition of the Journal of Bone and Joint Surgery Vol. 69-B, No. 1, January 1987, pp. 38-40 in the article entitled: "Nutritional Osteomalacia Presenting with Plantar Fasciitis":


The term plantar fasciitis refers to the clinical syndrome of heel pain with tenderness of the under surface of the heel at the point of insertion of the plantar fascia into the calcaneal tuberosity (Furey 1975).

Other terms for this condition include the heel pain syndrome (Tanz 1963) or subcalcaneal pain (Snook and Chrisman 1972). It is thought that traction on the calcaneus sets up a low-grade inflammation which may also cause a bony proliferation extending into the plantar fascia, the so-called plantar spur (Perry 1983). Factors associated with plantar fasciitis are age, obesity, athletic activity and seronegative arthritis (Lapidus and Guidotti 1965; Resnick et al. 1977).


What is going on:

There are many causes of heel pain such as infection, fracture of the heel bone, tendinitis or neuritis of the nearby tendons and nerves. One of the most common causes is plantar fasciitis. Trauma (with or without the added stress on the heel of overweight) may tear or stretch a few fibers of the plantar fascia enough to initiate a local repair inflammation. The initial tear heals in a shortened position unless deliberately stretched out while healing. Re-tears occur easily when stressed by the next significant strain on the plantar fascia. This cycle may repeat many times causing a chronic inflammation and chronic heel pain. Because the plantar fascia attaches to the heel bone, and because bone heals with bone, a chronic inflammation at the point of attachment of the plantar fascia may result in the development of a "heel spur" which can be seen on xray. The heel spur is the result of the long standing inflammation of repair, and is not the cause of the heel pain. Repair inflammation may be painless. Many heel spurs seen on xray are painless.


Severe heel pain on first arising from bed in the morning or on getting up from a chair after sitting for more than 10 minutes that tends to get a bit better after walking on it for 5 - 10 minutes is the classic symptom of plantar fasciitis.


What to do:

1. The first thing to do is to establish the diagnosis. Is your heel pain due to plantar fasciitis or not? It is imperative that the correct diagnosis be made. For this purpose seek professional medical advice.


2. The most important point in healing plantar fasciitis is to have the plantar fascia heal in the stretched position. When the tear heals in the stretched out position of the plantar fascia, the whole strength of the plantar fascia is resisting the next significant strain, not just the shortened, newly healed portion. This means that the likelihood of re-tear or significant re-strain is greatly diminished. Daily stretching exercises or sleeping in a splint that keeps your foot in the "up" position will help. A board can be constructed to be on a 10 - 15 degree up slant that can be used to stand on at the sink or washbasin. Ten to fifteen minutes of standing on such an incline with the toes up and the heels down will stretch out the plantar fascia while the tear is healing. There are several other stretching exercises such as a) standing 7 or 12 inches away from a wall with the heels on the floor and leaning into the wall keeping the knees straight; b) letting your body weight stretch the back of your calf by standing with your toes on the stairs letting your heels go down; c) the usual runners' heel stretching exercises is another way to stretch out the plantar fascia. Any and all of these stretching exercises may increase the pain temporarily. Such a temporary increase in pain is not reason to stop. No permanent damage to your plantar fascia is being done by gently stretching it to get it to heal in the elongated position.


3. Local heat will have the effect of making the heel feel better. Alternate hot and cold applied locally will increase the blood flow to the part and have the effect of "washing out" the collection of pain chemicals. Heat will ease the pain and relax the muscles allowing for more normal local blood flow. There are a number of easy ways to apply hot and cold to the part (e.g. 3 min. hot and 1/2 -1 min. cold) - shower or water baths or heating compress or electric pad and ice locally. Use a thermometer to measure the heat of the hot water. Start the hot water about 100F. (37.7C.) and increase the temperature by adding more hot water (without burning yourself) to a maximum temperature of 110F. (43C.). Add ice to the cold water to keep it cold and end the treatment with cold (at least three hots and three colds). If you have diabetes or peripheral neuritis or other disease that makes your body part insensitive to temperature, consult your professional medical providers before attempting to use hot and cold on yourself.


4. Anything that will relax the plantar fascia will also make the pain less because it is painful to stretch out inflamed tissue. While this makes the heel feel better, if the plantar fascia is not daily stretched out, great risk of re-injury and developing a chronic heel pain is taken. Ways to relax the plantar fascia are wearing higher than ordinary heels. A felt lift inside the shoe will do this. Just simply wearing shoes with higher heels will accomplish this. When combined with stretching exercises higher heels can be a useful temporary treatment method.


5. A great number of different kinds of heel pads are available to treat painful heels. One type is designed to increase your own heel padding by supporting the sides of your heel with rigid a plastic heel cup; other type adds softness and padding to your heel. A third type provides space under the center of the heel which increases the pressure elsewhere. What helps is likely right for you.

6. If all else fails before considering surgery see what an anti-inflammatory diet will do for you. What is an anti-inflammatory diet? Foods that come from plants. The less refined the food the better. Why are plant foods anti-inflammatory? It is because of the chemical messengers that are in plant foods (ecosinoids and prostaglandins) all have the effect of decreasing inflammation in our bodies. Try it. It will work! Why do I want to eat an anti-inflammatory diet? It will give you less pain. Pain comes from inflammation. It will also give you less blood clotting tendency for your blood. That would be nice!


Would you like to experience two or three weeks of rest and relaxation while eating an anti-inflammatory diet to heal your heel spurs in the beautiful Black Hills of South Dakota?

Visit the Black Hills Health and Education Center online athttp://bhhec.org or

call 1 (800) 658-5433