Column: Mourning morning heel pain?

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Commentary by Dr. David Sullivan

Stabbing, aching, sharp shooting and feeling like a stone bruise – these are some of the terms patients use to describe heel pain, especially on their first few steps out of bed or off the couch at the end of the day. The symptoms usually happen when there are mechanical issues with their feet, or they have added stress in some way. 

Plantar fasciitis is the most common heel pain diagnosis. It is caused by excessive physical stress to the plantar fascia, a strong, wide ligament that stretches from the heel to the ball of the foot.

Pain is often worse after any amount of rest because the fascia contracts when at rest from a physically demanding activity. When weight is placed on the foot, it naturally wants to flatten out, but the tight fascia does not want to stretch out adequately. This leads to over-pulling on the heel bone, where it attaches, or sometimes the arch, and this is what causes the intense pain.

Plantar fasciitis can be caused by one or a combination of the following: poor foot mechanics, tight calf muscles, weight gain, prolonged stance or walking, uneven terrain, shoes without support, new exercise routine or excessive barefoot walking.

If untreated for several months, the inflamed tissue thickens like scar tissue. Most patients respond very well to conservative treatment, with less than 3 percent requiring surgical intervention.

Treatment begins by determining the cause and may include orthotics, cortisone injections, anti-inflammatory medications, MLS Laser Therapy, shoe education, splinting, lifestyle changes and physical therapy. The longer and more intense the symptoms have been present, then usually the more aggressive the treatment needs to be.

A board-certified foot surgeon and wound specialist, Dr. David Sullivan is the owner of Westfield Foot and Ankle, LLC. Contact him at drs@westfieldfoot.com.


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