Pain in heel when walking, standing, or running. Especially first thing in the morning.
The use of diagnostic musculoskeletal ultrasound (or other imaging modalities) can help better define your injury, which may be more severe than you think. This may be why you are not improving as expected. Steroid injections and other anti-inflammatory medications (such as ibuprofen) fight inflammation. However, inflammation is not typically the problem after a period of time. The inflammatory aspect of these conditions does not typically persist after 3-4 weeks. Animal studies confirm that the tissue is degenerative. Specifically it is mucoid degeneration. (Mucoid describes tissue that is like mucous, which is not a very good quality in a tendon!) There are no White Blood Cells (WBCs) in this mucoid degenerative tissue. The WBCs are present in inflamed tissue. The tendon may also have a tear, either across the tendon (transverse) or, more typically, along the length of the tendon (longitudinal or intrasubstance tear).
Treatments for Plantar Fasciitis
You should stretch the injured associated muscle. For the plantar fascia, the stretch will involve the gastrocnemius and soleus muscles. With your mid-foot( not toes) on the edge of a step and your knee straight drop your heel over the step to stretch the gastrocnemius. Hold the stretch for 30 seconds. Do one leg at a time. Use both feet to raise onto your toes. Repeat with your knee slightly bent to stretch the soleus. Repeat three times several times daily.
- Commonly known as “negatives” in weight lifting terminology
- Use the same position as described for stretching. With your mid-foot (not toes) on the edge of a step and your knee straight, stand up on the toes of both feet. Slowly (over 3 seconds) drop your affected heel over the step to eccentrically load the gastrocnemii muscles, the Achilles tendon and the plantar fascia. Repeat. Work up to 30 repetitions, 3 times daily. Then do this with the knee slightly bent to eccentrically load the soleus muscle, the Achilles tendon and the plantar fascia. You can make it easier by leaning on something to take off some of the weight, such as the handrail on the stairs.
- These exercises should not be hard. The goal is not to build muscle but stress the tendon. If you have a slight amount of pain with these exercises, that’s okay. If you have more pain than a slight amount, you need to discontinue the exercise and try again in 2-3 days. It’s best to do these stretches after warming up for 10-15 minutes, such as on a stationary bike.
- Only consider steroid injections if stretching and exercise do not work
- Regenerative medicine can dramatically help the healing of golfers or tennis elbow. Read more about regenerative medicine here. (link to RM page)
2. Achilles Tendon Pain