Heel pain in the morning

“I can’t even stand on my heel in the morning!”

Heel pain on the bottom of your heel often is due to a condition called plantar fasciitis (‘fash-ee-itis’). Pain from plantar fasciitis is a sharp or stabbing pain felt on the bottom of your heel. In severe cases the entire sole of your foot can be painful. Usually your pain is worst first thing when stepping on the floor in the morning, especially in bare feet. There may be tenderness with pressing on the heel, and a tight tender cord may be felt on the bottom of your foot.

Heel

The plantar fascia is flat fibrous band of tissue on the sole of your foot. It runs along the bottom of your foot, attaching to your toes in front, and your heel in the back.

If the arch of your foot is thought of as a bow, then the plantar fascia may be considered the bowstring. It supports your arch and provides stability and protection to the foot.

Plantar fasciitis may be due to shoes with poor arch support, flat feet, overuse or new vigorous running or jumping sports. Weight gain from pregnancy or other causes may lead to heel pain from plantar fasciitis. If the calf muscles and Achilles tendon are too tight, it is easier to develop plantar fasciitis pain.

The diagnosis of plantar fasciitis is made from the type of pain, its location and an examination of the foot and lower leg. X-rays may be done to exclude any bone or joint abnormalities, but they will not show the plantar fascia itself.

The pain from plantar fasciitis may take weeks or months to resolve completely. Physical therapy with specific stretching exercises is very important in the treatment of plantar fasciitis. Arch support in shoes helps to take tension off the plantar fascia, and weight reduction may be useful. A rest from sporting activities may be recommended, or the condition may become chronic and much more difficult to treat. Although in the past, cortisone shots frequently were used, these are less popular now due to concerns about weakening the plantar fascia and the possibility that a tear could occur. Local use of ice and medications called non-steroidal anti-inflammatory medications (NSAIDs for short) are used to stop the pain and inflammation. Some of the more commonly prescribed of these include medications such as Ibuprofen, Naprosyn, Indocin and Celebrex. Plantar fasciitis splints which keep the foot in a flexed position are worn at night and often provide excellent results. In resistant cases, and as a last resort, various surgical procedures may be necessary. For more information about other common causes of foot pain, please visit http://www.painspot.com/, and take the foot pain quiz.

About Doug Roberts MD

Board certified practicing rheumatologist and founder of PainSpot.com
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