Off on the Wrong Foot:
Plantar Fasciitis/"Heel Spurs"
Robert A. Hayden, DC, PhD
Foundations are important. Stable structures are built on good, strong ones. Poor foundations cause whatever is over them to have problems.
Our feet are the foundations for our bodies. Healthy feet should allow a normal gait, symmetric distribution of weight, and free and easy movement throughout our lifetime. When feet work normally, we take them for granted. Most of the time, it is when our foundations are dysfunctional that we even take notice of them. We think we just got "off on the wrong foot."
Every day I see patients with arch pain, heel pain, bunions, and other conditions that have caused problems farther up in the knee, hip, sacroiliac joint, and lumbar spine. How can a problem in the foot cause misalignment and pain in the spine? Well, that's easy when you think about it: a body built on a poor foundation is not stable or durable, and eventually wear and tear will manifest itself somewhere at one or more stress points in the skeleton.
One of most common conditions seen in our practice is that of plantar fasciitis, sometimes know somewhat erroneously as "heel spurs." It is frequently a precursor or coexisting problem with low back pain. Upon examination, we find many times that the two complaints are related, perhaps as cause and effect. This happens so often that an assessment of the foot and gait is now a regular part of our low back exam.
The foot is beautifully constructed with three arches. The medial arch, or the instep, is the one that gets all the attention. Indeed, it is the only arch that has any support in most shoes on the market. Because shoes are mass produced, these arch supports are one-size-fits-all even in the best or most expensive of running shoes. Unfortunately, everyone's arch is different, and one-size-fits-all solutions are not always adequate.
[Insert picture of foot and bones with caption: The structure of the foot is carefully studied and assessed as part of the examination for conditions involving pain or dysfunction of the back, pelvis, knees, or feet.
There are two other arches in the foot that need support, though they are almost never addressed in foot wear. There is a lateral arch on the outside edge of the foot, and there is another natural arch just behind the ball of the foot that shapes the toes. Why are these arches almost never supported by your shoes? The answer is in mass production. Shoes are made all alike, while feet are all different. Manufacturers simply could not make arch supports to fit real feet. The consequence of this fact is that feet are thus forced to fit the shoes!
Let's look at plantar fasciitis more closely, because it is one of the most common problems we see in the clinic. This monster can really bite, but it can be controlled.
Most people can point to the Achilles' tendon. If you trace the Achilles' tendon down from the calf to the heel, and then to the sole of the foot, that tendon becomes the plantar ligament. It is this ligament that holds the arches of the foot in place. When this ligament stretches out of shape, the arches fall, the ligament becomes inflamed, the foot loses integrity as a foundation, and pain eventually results.
This condition prefers females by about 2:1, but males get it. Indeed, somewhere from 11 to 16% of the population have plantar fasciitis. There are some risk factors in the research literature, such as being overweight, abnormal gait, running on hard surfaces, etc. Some see the condition as a normal consequence of aging. In my own practice, I also see it manifest in people who wear shoes that do not properly fit, or that are not well suited to human feet?like many high heels in women's shoes.
[Picture of high heel here] Caption: Shoes that look good to us may be very painful and harmful.
Some refer to this condition as a "heel spur." One of the reasons this is a misnomer is that only about 30% of people who have it show spurs by x-ray. X-rays of the feet should be obtained for study to rule out stress fractures, osteoporotic fractures, genetic anomalies, arthritic conditions, etc. More often than not, the x-rays are clear of obvious problems. The diagnosis is made on the history and physical examination once other conditions are ruled out radiographically.
The typical pain associated with this condition focuses on the heel, but it may also project to the entire bottom of the foot. The arches and balls of the feet may be sore. Typically, the pain recedes after sitting or lying down for a while, but the first few steps offer instant reminders that it is still there. Later in the day when you have been standing for a while, the pain might ease off some, only to be exacerbated then next time you stand up.
What can be done about this painful problem of the foot? There are several things you can pursue. Here are some:
Rest: For runners, it may be advisable to decrease or stop running for a while. If you live in Griffin and Spalding County area, there are some well-known walking tracks with soft rubber surfaces (made from recycled tires). These are excellent places to exercise even if you don't have foot pain because the softer surface absorbs shock as you run or walk.
Ice the heel after walking or exercising to help bring down swelling. Some people freeze water in a plastic drink bottle and roll the bottle under the feet. This gives some people significant relief.
Exercise to help build muscle strength and joint stability to prevent this problem. Once it is here, you will still be able to walk and exercise with proper treatment.
The joints of the foot, ankle, knees, hips, and sacroiliac joints can be adjusted by a chiropractor who does extremity work. In many cases, the cause of the problem can be identified and corrected through improved alignment of body structures.
Over-the-counter pain relievers may help temporarily, such as ibuprofen. It should be remembered, however, that even though such anti-inflammatory drugs may help for a while, these drugs are not benign. The side effects may be serious. In fact, one of every 1,200 people who take ibuprofen will die from the drug's effects on the kidneys and the lining of the stomach. Topical preparations, such as menthol, may also provide some temporary relief.
Because shoes are one-size-fits-all, they will not support your foot's unique shape. Custom orthotics can be made to support your foot exactly and uniquely. Once the alignment has been restored to the foot, knee, and pelvis, have a set of foot orthotics made to protect the heel and to help the adjustments hold better. Stabilizers for this condition can be designed to provide a protective "cushion" around the heel area, and also change your foot's posture to help take pressure off the spurs and make you more comfortable. It is my experience in practice that the vast majority of patients find their most lasting relief with orthotic supports for the feet.
The foot is scanned electronically to assess the arches. The scan is sent via internet to the laboratory, where the orthotic supports are made.
The surgical option is not usually necessary. Most of the time, this condition responds very well to conservative measures. As always, surgery should be a last resort to be contemplated only when conservative means have been exhausted without the desired effect. Once you rearrange your anatomy, there is no going back!
This type of orthotic support replaces the standard insole of your shoe, and can be used in any shoe of the type for which it is designed.
If you are one of the 11 to 16% who have painful plantar fasciitis, see a health care professional and ask questions. Relief from most conditions usually starts with getting answers.
Remember that conditions like this are not usually cured. They are controlled with rational, conservative, science-based approaches. See your favorite doctor for advice if you have this condition, and don't get "off on the wrong foot."