• My heel hurts when I get up

    16th March 2015 | donaldt
  • Does your heel hurt when you get up first thing in the morning? 

    This description is the classic presentation of a condition referred to as plantar fascitis an inflammatory reaction in the sole of the foot where the plantar ligament attaches to the heel. 

    This condition tends to occur in middle aged people. It presents with vague heel discomfort which comes and goes without any specific pattern and may occur in one or both feet.  When severe this condition poses a serious disabling effect on the individual by limiting the ability to walk well and function normally. It is difficult to predict when this condition will cause severe pain, however it is possible to take precautions to help avoid the pain from coming on or getting worse. 

    Inappropriate footwear, being overweight and altered foot mechanics all have a bearing on the development of plantar fascitis.  Wearing shoes with adequate support as well as adequate assessment of ones foot mechanics all lead to the avoidance of developing this condition.  In fact simple arch supports can make a big difference especially in people who have a tendency to have collapsed arches.  A collapsed arch puts increased tension on the plantar ligament.  This increased tension may develop an inflammatory reaction in the heel hence the name plantar fascitis.  Supporting these arches decreases the tension in the area and avoids a recurrent inflammatory process which is what tends to make the condition worse. Recurrent inflammation in the area may lead to the development of a heel spur which in reality is like an inverted pin. If present this spur would be constantly pressing on the ligament of the heel causing inflammation and pain.  Increased weight inevitably puts more pressure on the heels leading to further aggravation of the inflammatory process.  

    Stretches carried out first thing in the morning, whereby one grabs the toes, pulls them towards the body holding them for ten seconds helps to decrease the discomfort.  Ice also helps to numb the pain and decrease any swelling present. Heel supports which come in various forms cushion the sore area.  Rest, decreasing activities that make one’s feet hurt and avoiding walking or running on hard surfaces all contribute towards alleviating the symptoms of this condition.

    Physiotherapeutic examination and treatment is recommended to:

    1. Screen one’s feet through a biomechanical examination which involves taking a close look at the way the feet function. 
    2. Advice on any orthototics which may be necessary to support the feet. 
    3. Decrease swelling, stimulate healing, decrease pain and prescribe exercise.
    4. Shockwave therapy is considered to be a useful method of treatment which helps in the treatment of plantar fasciitis.
    5. Acupuncture has also been found to be very successful in treating this condition.

    An x-ray of the foot is sometimes requested to establish if there is a heel spur.  Anti inflammatory medication helps to decrease the inflammation and pain but does not solve the problem.  Steroid injections are sometimes administered to help decrease the inflammation.  Surgery is not highly recommended in this region.  All this makes it all the more important to take the necessary precautionary measures to avoid this condition from setting in. One’s ability to walk pain free is often taken for granted and it is only when such ability is impaired does one realise how important this function is in our daily life.  Simple precautionary measures such as foot screening, wearing appropriate footwear and seeking timely advice when discomfort sets in will decrease the longstanding disabling effects associated with this condition.