Healing Heels

If your heel hurts when you take your first steps in the morning or while walking throughout the day, you may be dealing with plantar fasciitis, one of the most common types of heel pain.

According to sports medicine specialist the plantar fascia is fibrous tissue that stretches from the heel bone to the ball of your foot. It fans out along the sole of your foot and provides support to your arch.

“The plantar fascia is important when you walk or run because it acts as a shock absorber,” Dr. Flannery says. “Sometimes it can get pulled or tear because of an increase in your activity level. When you sleep, the tension is off the plantar fascia, but when you get up, you feel it. I've heard people describe it as if they’re walking on glass.”

What Causes Plantar Fasciitis?

Besides increased activity, plantar fasciitis can result from:

Tight calf muscles
Flat feet
Chronic overuse
Age

“In the athlete, it can occur when you push off or start to run,” he says. “We commonly see it at the beginning of the season, especially if the person hasn't been training a lot. Plantar fasciitis can affect anyone at any age and athletic level.”

Heel Pain Relief

Unfortunately, plantar fasciitis can take a long time to heal if you ignore the problem. According to Dr. Flannery, if you're dealing with heel pain, you should:

Rest your foot
Ice it several times a day by rolling your foot over a frozen tennis ball or water bottle
Take anti-inflammatory medicine, such as ibuprofen or naproxen, for two or three weeks
Do stretching exercises for the plantar fascia
Sleep with your foot immobilized using a special boot – sold at many pharmacies -designed to hold the foot at a 90-degree angle

If that doesn't relieve your pain after a few weeks, then see your doctor, Dr. Flannery says. Your doctor will likely ultrasound your foot to make sure it's not torn. Afterwards, the recommendations might include:

Physical therapy to calm the pain

Prescription medications
A corticosteroid injection

Minimally Invasive Procedure for Persistent Pain

If it's been more than 90 days and the pain hasn't responded to these conservative treatments, you may need to consider a different treatment option.

One such option is Tenex®, a minimally invasive procedure performed at University Hospitals Westlake Health Center. It works well to repair the body's tendons, such as shoulders, elbows, wrists, knees and/or heels, Dr. Flannery says.

“The plantar fascia is one of those areas that isn't a great surgery option,” Dr. Flannery says. “That's why Tenex is beneficial.”

How It Works

If you're a candidate, the procedure is done on an outpatient basis. After either a local anesthetic or light sedation depending on your preference, the area will be cleaned and a very small incision made.

Next, a small needle is inserted. This uses high frequency vibrations to break up any scar tissue along the plantar fascia. Saline water is used to both cool the needle and to remove debris.

“It works in a way similar to a dentist’s drill,” says Dr. Flannery. “The dentist sets the drill to a certain amount of resistance and when it gets into healthy stronger tissue, it stops.”

After the diseased tissue is removed, the wound is closed. Instead of stitches, usually two or three small adhesive strips are applied. This keeps scarring to a minimum.

Recovery Time

The healing time usually takes about six weeks. Following the procedure, you'll wear a boot for seven to 14 days and won't require crutches. After four weeks, most people can begin a walking routine to get back into shape, but no running or dancing.

“At the six-week mark, you're usually ready to go,” Dr. Flannery says. “This is a very safe procedure. It's minimally invasive with very little scarring and can be done on an outpatient basis. And you can get back to pre-injury level of functioning fairly quickly. Around 80 percent (of patients) do better and none have been made worse.”