Plantar Fasciitis

Why Do My Feet Hurt In The Morning?

My wife says, “when your feet hurt you hurt all over…”.  I used to chuckle at that statement until I discovered just how many people actually have chronic pain in their feet.  According to Podiatrists (foot doctors) 75% of Americans experience some form of serious foot pain some time in their life.

I have had people specifically ask me, “Why do my feet hurt in the morning?” As there are many causes of foot pain, I looked up whether morning foot pain was more specific for a given foot disorder.  In fact, it is…a disorder called Plantar Fasciitis (PF).

How Plantar Fasciitis Happens ?

Plantar Fasciitis

Plantar Fasciitis (also called “jogger’s heel”) is a structural breakdown of the plantar fascia (a ligament on the bottom of your foot). More recent studies have shown structural changes (particularly at the attachment of the plantar fascia to the heel) consistent with a degenerative process.

Though inflammation can be involved, it is usually characterized by a weakening and “shredding” of the attachment sites of the  plantar fascia.  Because the inflammation may not be robust the usual anti-inflammatories may not give much relief.

What Causes Plantar Fasciitis?

PF is the most common cause of heel pain in America.  You see it in people with flat feet, who stand for long periods of time, women (due to high heels), obesity, joggers, and any activity that places undue stress on the bottom of the foot.

Also, anyone with an already existing arthritic condition may be expected to develop this more commonly (ie. rheumatoid arthritis).

How Does It Feel?

REMEMBER…THE BEGINNING OF YOUR THERAPY ALWAYS STARTS WITH A THOROUGH HISTORY AND PHYSICAL BY YOUR PRIMARY CARE PRACTITIONER. YOU MAY REQUIRE ADDITIONAL DIAGNOSTIC TESTING.
The pain is usually sharp, located at the heel, and strangely, usually on one foot only.  As I said before, it usually hurts in the morning with the first few steps. With continued walking the pain will often diminish.  It is one of the orthopedic syndromes where the pain gets worse after a rest period.

When examined, the person usually will complain of a sharp pain when pressure is applied to the area on the sole of the foot just in front of the heel.  Also, moving the front of the foot towards the shin (called dorsi-flexion) also causes pain.

How Can You Obtain Relief From Plantar Fasciitis?

I divide the therapies into non-invasive and invasive:

Non-invasive Therapies:

1)  Shoe wear:  I hate to say it ladies, but, the high heels will have to go.  The best shoe wear will pad the sole of the foot, have a high arch, and a rounded sole (front to back).

Plantar Fasciitis

2) Plantar stretches:  either with your hand, a towel, or squatting.  The idea is to stretch the bottom of the foot several times a day for 5 minutes.  It is a good idea to do this if you have been at rest for a while.  Stretch before you get up to move…it will make those first few steps less painful.


Plantar stretches

3) Anti-inflammatory Medication (ie. like Motrin):  I always recommend a thorough history and physical examination by your primary care practitioner (PCP). Have him/her prescribe the appropriate medication for you.  I have recently written a review on Motrin.

Motrin

4) Taping/bracing:  there are a number of similar taping and bracing techniques that will stretch the plantar fascia while you are at rest.  See your PCP for the correct way to do it.

5) Other:  you will see Shockwave Therapy, Radiotherapy, etc. on the internet.  Use wisdom investing time and money in these therapies.




Important Note
IF THE PAIN PERSISTS AFTER 6 MONTHS OF CONSERVATIVE THERAPY YOU WILL NEED TO SEE AN ORTHOPEDIC/PODIATRIC SURGEON OR A PAIN SPECIALIST. 20% OF PEOPLE WILL FAIL WITH CONSERVATIVE THERAPY ALONE.

Invasive Therapies:

1)  Cortico-steroid injections:  these offer relief for up to 3 months.  Their administration can be very painful at first.  Many people will require multiple injections.  I like the side injection best as it does not pierce the plantar fascia.  Walking on the area of puncture may increase the risk of infection after the injection.  I used a special mix of medications when I performed this type of injection

Cortico-steroid injections

2) Open Surgical Procedures:  obviously these procedures require a board certified surgeon who is experienced in foot surgery.  I have found that Podiatric Surgeons are more motivated to operate than Orthopedic Surgeons (perhaps because Orthopedic Surgeons operate on other areas of the body as well).

Open Surgical Procedures

Finally

Plantar Fasciitis is a very painful condition that usually resolves with conservative therapy. There is hope of relief for you if you follow the guidelines outlined in this monograph. This condition tends to take many weeks to months to resolve even with therapy. You will eventually improve…don’t lose hope.

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