It doesn’t matter if you’re an “early bird” who springs right out of bed in the morning or a “night owl” who sleeps right through the alarm after a late night, you don’t want to wake up to sharp pain in the bottom of your heel!
If you do have a stabbing heel pain that accompanies your first steps after a night’s sleep—whenever you happen to wake up—the odds are pretty good you have a condition called plantar fasciitis.
Heel Pain in the Morning
The most easily recognizable symptom of plantar fasciitis is that sharp pain in the back of your foot, right underneath your heel. As noted, you will usually encounter this with the first steps of the day, but why does this happen?
Well, the key anatomical feature at play for this injury—the leading cause of adult heel pain—is a fibrous tissue known as the plantar fascia.
This particular fascia runs lengthwise along the bottom of the foot and bridges the front of the foot to the heel bone (calcaneus) in the back. Some of the functions of the plantar fascia include supporting the foot arch, assisting with a biomechanical process known as pronation, and absorbing some of the physical forces that come from taking a step.
Plantar fasciitis is considered to be an overuse injury and is the result of excessive strain or stress placed upon the fascia. In turn, this leads to tiny tears in the tissue. A cycle of repeated stretching and tearing causes inflammation—the “-itis” suffix means “inflammation”—and pain as the damaged tissue is further irritated.
The heel pain will typically subside in time as you move around during the course of the day, but this does not mean the condition is healed. In fact, you will likely feel the sharp pain again once you start walking again after periods of rest or time spent standing in one spot. The explanation for this—and the prominence of pain in the morning—is simply the fact your body starts repairing the damaged fascia during those times of rest – but then the subsequent steps rip the tears open again.
Plantar Fasciitis Treatment and Prevention
Fortunately, nonsurgical care is often effective in treating plantar fasciitis. Nonsteroidal anti-inflammatory drugs (NSAIDs)—like ibuprofen or naproxen—are useful in relieving the pain, while at the same time reducing inflammation in the tissue.
Medication is a decent starting point, but it is not enough on its own. You can also benefit from stretching and strengthening exercises for your lower limbs. This doesn’t necessarily apply to all patients, but there’s a chance we may either recommend off-the-shelf shoe inserts or, even better, prescribe custom orthotics to help redistribute pressure on your feet in a more equitable manner.
For extreme inflammation, over-the-counter anti-inflammatory medications might not be effective. A corticosteroid shot might be more effective.
Whereas conservative care is often successful, there are very rare occasions when we recommend surgery for a severe case. This is normally a procedure to detach the affected plantar fascia from the calcaneus. We reserve this kind of aggressive treatment only when nonsurgical options are not providing the results we hope to see. In part, this is because the procedure can leave the foot arch somewhat weakened afterward.
One of the best methods for preventing plantar fasciitis is to stretch on a regular basis—even five minutes a day can make a huge difference—to keep tissues in your feet limber. If you need specific recommendations for stretching exercises, contact our office.
If you are a runner, you may need to alter your gait pattern so that you land on the midfoot, instead of using a heel strike. This will keep your plantar fascia relaxed, while also reducing the amount of impact your heels sustain. Keeping your legs relaxed as possible is another consideration to reduce your risk of this common overuse injury.
For additional information on heel pain, or to learn more about the foot care services we provide, give us a call at (972) 690-5374. While on the phone, request your appointment for professional care and treatment here at Richardson Podiatry Center.