December 2007

Heel Pain and Plantar Fasciitis

By Elliot Wagner, O.M.D., L.Ac., Doctor of Oriental Medicine

The plantar fascia is a band of tendinous tissue that supports the sole of the foot, gives structure by acting as a "bowstring" to keep the structures of the bottom of the foot taut and springy, and provides shock absorption. Because in walking or running the fascia serves to provide a springing action to the step, it is normally in tension. This makes it vulnerable to problems caused by overuse or insufficient stretching before athletic activity. This tension, when it becomes excessive, can create microtears in the fascia, cause the fascial tissues to become inflamed, and may initiate a gradual breakdown of the collagen (the structural protein that makes up many of the tissues of the body) of the foot. Eventually, this degenerative process causes stiffness and pain, and is given a name: plantar fasciitis.

What causes heel pain is not, as many people believe, bony spurs on the heel. Although they do form on the heels of many people with plantar fasciitis, the bony overgrowths that used to be blamed for heel pain are actually the result of the additional tension on the heel caused by the degeneration (drying) and tightening of the fascia. These spurs are the body's effort to strengthen the weakest part of the structure of the sole of the foot: the point of attachment of the fascia on the heel bone (the calcaneus). They are not generally the source of pain themselves.

Overuse — either among regular athletes, or weekend warriors who may not apply proper stretching and training between periods of intense activity — is a common factor in many cases of plantar fasciitis, particularly when it includes an increase in weight-bearing activities, such as running. The problem can be compounded by inherited or acquired tightness and weakness in the Achilles tendon, calf or intrinsic foot muscles. Plantar fasciitis also occurs commonly in older patients, who may have poor intrinsic muscle strength due to lack of activity or gradual degeneration of the plantar surface, coupled with poor healing capacity.

How do you know if you have plantar fasciitis? Most plantar fasciitis pain is centered in the middle, or just forward of the middle, of the bottom of the heel. However, many people have pain on other parts of the bottom of the heel, or in the center of the sole of the foot, or on either side. Some find that their pain moves around. Another sign of plantar fasciitis is the classic one of pain that occurs with the first few steps in the morning — but not every patient has this symptom. Some individuals notice pain at the beginning of activity, and find that it that lessens or resolves as they warm up. Others notice worse pain with standing, particularly those who must stand for long periods on the job.

What should you do if you have plantar fasciitis? Treatments judged most effective for plantar fasciitis include non-steroidal anti-inflammatories (NSAIDS) for pain, fitted splints worn at night to keep the bottom of the foot stretched, physical therapy guided foot strengthening exercises, rest, wearing well cushioned shoes, changing running shoes every 400 miles or so, and replacing hard floors with carpeting. Each of these has been found particularly helpful by individual patients.

As a practitioner of Oriental medicine, I have found that acupuncture helps many patients with plantar fasciitis, including those who have found that other treatments did not provide relief, or enough relief. Acupuncture treatments are directed toward improving circulation to and in the foot, which reduces inflammation, repairs tissue, builds collagen, improves stiffness, and relieves pain. Acupuncture treatments coupled with medicinal herbal formulas to increase circulation are better yet, and provide an effective means to restoration of normal functioning and activity.