This is kind of long and technical but will explain what is happening.
plantar fasciitis - Trauma may tear or stretch a few fibers of the plantar fascia enough to initiate a local repair inflammation. The initial tear heals in a shortened position unless deliberately stretched out while healing.
Re-tears occur easily when stressed by the next significant strain on the plantar fascia. This cycle may repeat many times causing a chronic inflammation and chronic heel pain. Because the plantar fascia attaches to the heel bone, and because bone heals with bone, a chronic inflammation at the point of
attachment of the plantar fascia may result in the development of a "heel spur" which can be seen on a x ray.
The heel spur is the result of the long standing inflammation of repair, and is not the cause of the heel pain. Repair inflammation may be painless. Many heel spurs seen on x rays are painless.
Severe heel pain on first arising from bed in the morning or on getting up from a chair after sitting for more than 10 minutes that tends to get a bit better after walking on it for 5 - 10 minutes is the classic symptom of plantar fasciitis.
What to do:
The most important point in healing plantar fasciitis is to have the plantar fascia heal in the stretched position. When the tear heals in the stretched out position of the plantar fascia, the whole strength of the plantar fascia
is resisting the next significant strain, not just the shortened, newly healed portion.
This means that the likelihood of re-tear or significant re-strain is greatly diminished. Daily stretching exercises or sleeping in a splint that keeps your foot in the "up" position will help. A board can be constructed to be on a 10 - 15 degree up slant that can be used to stand on at the sink or washbasin. Ten to fifteen minutes of standing on such an incline with the toes up and the heels down will stretch out the plantar fascia while the tear is healing.
There are several other stretching exercises such as
a) standing 7 or 12 inches away from a wall with the heels on the floor and leaning into the wall keeping the knees straight;
b) letting your body weight stretch the
back of your calf by standing with your toes on the stairs letting your heels go down;
c) the usual runners' heel stretching exercises is another way to stretch out the plantar fascia. Any and all of these stretching exercises may increase the pain temporarily. Such a temporary increase in pain is not reason to stop. No permanent damage to your plantar fascia is being done by gently stretching it to get it to heal in the elongated position.
Local heat will have the effect of making the heel feel better. Alternate hot and cold applied locally will increase the blood flow to the part and have the effect of "washing out" the collection of pain chemicals. Heat will ease
the pain and relax the muscles allowing for more normal local blood flow.
There are a number of easy ways to apply hot and cold to the part (e.g. 3 min. hot and 1/2 -1 min. cold) - shower or water baths or heating compress or electric pad and ice locally. Use a thermometer to measure the heat of the hot water. Start the hot water about 100 F. (37.7 C.) and increase the temperature
by adding more hot water (without burning yourself) to a maximum temperature of 110 F. (43 C.). Add ice to the cold water to keep it cold and end the treatment with cold (at least three hots and three colds).
If you have diabetes or peripheral neuritis or other disease that makes your body part insensitive to temperature, consult your professional medical providers before attempting
to use hot and cold on yourself.
Anything that will relax the plantar fascia will also make the pain less because it is painful to stretch out inflamed tissue. While this makes the heel feel better, if the plantar fascia is not daily stretched out, great risk of re-injury and developing a chronic heel pain is taken.
Ways to relax the plantar fascia are wearing higher than ordinary heels. A felt lift inside the shoe will do this. Just simply wearing shoes with higher heels will accomplish this. When combined with stretching exercises higher heels can be a useful temporary treatment method.
A great number of different kinds of heel pads are available to treat painful heels. One type is designed to increase your own heel padding by supporting the sides of your heel with rigid a plastic heel cup; other type adds softness and padding to your heel. A third type provides space under the center
of the heel which increases the pressure elsewhere.
Wear well-made, comfortable shoes whenever possible. Anyone with heel pain, especially runners, should stretch regularly, and consider the use of supportive orthotics.
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