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Heel Pain Epidemic Afflicts Weekend Athletes

American College of Foot and Ankle Surgeons Offers Prevention/Treatment Tips

PARK RIDGE, Ill., July 17, 2002 – Heel pain among weekend sports participants, runners and those beginning exercise programs is reaching epidemic proportions, according to a leading podiatric sports medicine expert with the American College of Foot and Ankle Surgeons.

"We’re seeing a lot of heel pain these days, and much of it can be traced to preventable causes, such as stress from excessive athletic activity and poorly designed footwear," said Richard T. Bouché, DPM, FACFAS, a podiatric foot and ankle surgeon at Virginia Mason Sports Medicine Clinic in Seattle.

According Bouché, if an athletic shoe bends in the middle, it may not provide the required stability and protection against heel pain. "The shoe should bend in the area in which the toes bend and not at the arch," said Bouché. "Heel pain is a very common ‘overuse’ sports injury and weekend athletes should wear well designed athletic shoes specific for the shape of their feet."

Bouché added that that when heel pain occurs, it’s best decrease and sometimes eliminate strenuous athletic activity until the pain subsides and seek treatment if symptoms persist.

It is estimated that 15 percent of all adult foot complaints involve plantar fasciitis, the type of heel pain caused by chronic inflammation of the connective tissue extending from the heel bone to the toes. Conservative treatment is effective in most cases and initial options include: anti-inflammatory medications, padding and strapping of the foot, stretching exercises for the calf and plantar fascia and icing. Also, anyone with heel pain should not walk barefoot, wear flat shoes or use arch supports. More extensive treatments may involve wearing night splints to stretch the calf muscles and plantar fascia while asleep, custom orthotic insoles, steroid injections, deep massage and strengthening exercises.

Bouché noted that surgical options may be considered when conservative treatment fails to remedy heel pain. For plantar fasciitis, the fascia may be partially or totally released (plantar fasciotomy), and if a heel spur is present, it may be taken out as well.

Heel pain surgery normally is performed on an outpatient basis under regional or local anesthesia. Patients may be required to use crutches after surgery and progress to a walking cast and physical therapy after a variable period of time. For an athlete, it may take four to nine months of recovery before an unlimited return to sports activity is allowed.

A relatively new non-invasive technique, extracorporeal shock wave therapy, also is effective for treating severe, chronic heel pain in adults. This new procedure uses a device to generate shock waves aimed at the treatment site. The shock waves achieve therapeutic results by increasing blood flow to trigger a healing response. This eases inflammation in the heel and relieves chronic pain.

This article was provided with permission by the American College of Foot & Ankle Surgeons.

Dr. Nelson's "Top 10 Tips" for Treating Plantar Fasciitis (aka - "Heel Spurs")

1)    Wear a custom-made prescription orthotic (best treatment) or a high quality pre-made type arch support, like Orthofeet BioSole. - *very important*
2)    Use a plantar fasciitis night splint, while sleeping or sitting down to gently stretch the plantar fascia and prevent it from tightening. - *very important*
3)    Do "runner's stretches" (or other stretches) to stretch the back of the calves and the arch of the foot. - *very important*
4)    Stretch the arch of the foot in bed before getting out of bed in the morning.
5)    Don't run, jog or use stair climbers until the pain resolves.  Wear supportive, cushioned, "athletic" type shoes.
6)    Apply ice to the arch and heel after being active on the foot.
7)   Consider taking anti-inflammatory medications (NSAIDs), if you can tolerate them, but be cautious of possible dangerous side effects.
8)    Don't climb ladders, don't walk barefoot, avoid going up/down stairs, avoid prolonged walking/standing, don't rest the arch or heel on cross bars and avoid smoking.
9)    If overweight, try to lose weight.
10)  If not improving, see your podiatrist who may be able to offer you other treatments, such as "cortisone" injections, anti-inflammatory medications, extracorporial shock wave therapy, physical therapy, surgery and more.

You don't have to suffer with heel pain.  You can get rid of your heel pain if you follow each of the top 5 suggestions listed above.  If you do each of the top 5 suggestions on a daily basis, you have over a 90% chance of eliminating your pain due to plantar fasciitis (heel spurs). 

Successfully relieving plantar fasciitis heel pain requires using a variety of synergistic treatment modalities.  The goal is to stop the activities which are irritating the plantar fascia, position the foot into the correct anatomical alignment, reduce strain on the plantar fascia while standing/walking, calm down the inflammation and stretch out the plantar fascia, so that it can heal properly in an elongated position.  The longer you let heel pain go untreated, the harder it becomes to eliminate the pain.  For most people, using a combination of arch supports/orthotics, a night splint while sleeping or sitting down, stretching twice daily and modifying their activities is sufficient to make their plantar fasciitis heel pain progressively resolve.  Fortunately, surgery is rarely needed.  Keep a positive attitude and remember that, yes, you can usually eliminate your heel pain by using these treatment suggestions.

The Strassburg Sock ™

The Strassburg Sock treats plantar fasciitis heel pain at night while you sleep in comfort.  Plantar fasciitis is also commonly called "heel spur syndrome" or "heel spurs".  This style of night splint is much more comfortable to wear while sleeping than traditional hard plastic back (or front) style night splints.  Plus, the Strassburg Sock night splint is much less expensive than most other styles of night splints.

Which Orthotic / Arch Support Should I Use?

Dr Nelson's comments: 
The best fitting and functioning type of arch support is a custom made prescription orthotic, which can be made by your podiatrist.  Generally, for most people, I recommend trying a pre-made arch support before progressing to an expensive pair of custom made orthotics.  Finding a comfortable and effective pre-made arch support can be difficult.  There are hundreds of varieties on the market and that can make it confusing for customers.  Due to the variations in people's foot shapes, foot problems and style variations in different products, there is no "one type fits all" arch support available.  That's why DrNelsonClinic offers different brands and models like OrthoFeet, SuperFeet, WalkFit and PowerStep to choose among.  Fortunately, for most people, I've found that the OrthoFeet BioSole gel self-molding orthotics work the best and fit almost everybody.  Among the hundreds of pre-made arch supports I've seen and used, the OrthoFeet BioSole models give the best support and pain relief for people with plantar fasciitis and heel pain.  It's by far my favorite model for people with heel pain, due in part to the higher arch and shock absorbing gel under the heel.  Be aware that the standard OrthoFeet BioSole "sport" model is rather thick through the arch and it fits into athletic, work boots and walking shoes, but may not fit into a shallow shoe, like a dress shoe.  If you want to use the OrthoFeet in a shallow shoe, like a dress shoe, then use the "thin-line" or "high heel dress" models.  The "sport" model may also be too high in the arch area for people with very flat feet.  For elderly or arthritic people and those that want extra cushioning and softness under the foot, while still getting extra support under the arch, try the OrthoFeet BioSole "soft" model.  If you don't need extra arch support or heel pain relief  and only want shock absorption and cushioning under the foot, try the OrthoFeet "ThermoFit" model.  After you start using any brand of arch supports, remember to break them in gradually, because is will take some time for the orthotic and your feet to adjust to each other.  I personally use the OrthoFeet BioSole sport model in my athletic shoes and have found them to be as effective and comfortable as my expensive custom prescription orthotics.  But, it did take longer to "break-in" the OrthoFeet supports than my custom orthotics.  If you don't have plantar fasciitis or heel pain or if you have a flat foot and can't tolerate an arch support with a higher arch, but still want great foot support to relieve foot fatigue and strain, you should also consider SuperFeet Synergizer orthotics, which are our most popular arch supports.  SuperFeet Synergizer orthotics have been highly recommended by sports and outdoor publications such as Backpacker™ magazine. 

Learn more about:

        Orthotics to improve your running.
        Heel Pain Treatment.
        Running and Your Feet.

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