10/5/2015: Do you  have heel pain with the first few steps in the morning?

-Dr. Sean Reyes, Las Vegas Podiatrist 24/7 Foot doctor

Heel pain in the morning? You may have plantar fasciitis. I go more in depth with heel pain here, but I would like to give a brief overview of why this problem is treatable and most see excellent results with conservative care.

The most common complaint with plantar fasciitis is what I stated above: heel pain first thing in the morning with your first few steps. But that’s not the only time, anytime you’ve been sitting for long periods then get up and the first few steps again are painful is another sign. The pain may continue throughout the day as well even if you’ve been walking awhile and during strenuous activity. (Of note: please see a podiatrist though as these signs do not mean you automatically have plantar fasciitis and will need x-rays and a full workup to determine the cause of the pain). Besides ingrown toenails, plantar fasciitis is the 2nd most common thing I see. It may even be more common than ingrown toenails the more I think about it. The etiology of plantar fasciitis can be explained here, but below is a brief overview of some things you can do to alleviate the pain in the meantime.

  • Stretch-There are many exercises your podiatrist or physical therapist can show you. As seen below on the left, stand against a wall with the foot you want to stretch in the back. Gently lean forward until you feel the stretch and hold it. Remember to keep your heel on the ground as you do this and also remember to breath. Hold it for 15-25 seconds. Another stretch you can do is hang your heel off the edge of the steps and gently lower yourself down as seen in the photo on the right. Unlike my photo, wear shoes when you do this. And finally, anytime your sitting down you can stretch by putting your leg out in front of you, keep it straight or slightly bent at the knee, and wrap a towel around the bottom of the forefoot while holding the towel and gently pull your foot back.

  • Roll the bottom of your foot over a frozen water bottle- This helps with inflammation and pain.

  • Take OTC NSAID such as Ibuprofen

  • Wear a night splint- This is hit or miss. Some patients see great results with this while others can’t stand it because the night splint is hard to sleep in, especially if you are a stomach sleeper.

  • Physical therapy- You will need a prescription from your podiatrist but physical therapists have numerous techniques to help alleviate the pain associated with plantar fasciitis.

  • Cortisone shot- Again, you will need to see a podiatrist for this but an injection of steroid into the heel can provide immediate results. However, you do have to limit yourself to these injections as you shouldn’t get more than 3 injections a year in my opinion. In my experience about 25% see a small improvement, 25% see significant improvement, 25% get no improvement, and about 25% it takes care of the problem completely. Again, technique is important as is the ratio of the steroids.

  • Arch supports/Custom made orthotics- You will have to see a podiatrist if you choose to get custom made orthotics. If not, a good pair of OTC orthotics with arch support will do just fine in the meantime (and no, not Dr. Scholls)