Heel pain can turn chronic if it's left unchecked

As if the first steps out of bed in the morning aren't torturous enough already, many people suffer stabbing pains in their feet as they limp their way to the bathroom.

That morning symptom is a hallmark of plantar fasciitis, a common source of heel pain, which in turn is the top persistent foot ailment and among the most debilitating, according to the American Podiatric Medical Association. A 2009 association survey found that 40 percent of Americans have suffered heel pain, and in 60 percent of those cases it has interfered with people's daily activities.

The pain is easy to ignore at first, as it eases after you walk around a bit. But it's unwise to leave it unchecked.

"It is so much harder to get rid of heel pain the longer you let it go," said Marlene Reid, co-owner of Family Podiatry Center in Naperville, Ill., and president of the Illinois Podiatric Medical Association.

Plantar fasciitis, an inflammation of the band of tissue that runs along the bottom of the foot from the heel bone to the toes, makes news when it sidelines professional athletes. Though engaging in strenuous sports is one way to tear and inflame the fascia, other causes abound, such as being overweight, having high arches or flat feet, standing or walking for long periods on hard surfaces such as cement, or wearing unsupportive shoes.

Open-heeled shoes such as flip-flops, slides or sandals are common culprits, as are new shoes your feet aren't accustomed to and old shoes with worn-out heels, Reid said. This is one of the few conditions for which high heels are not the evildoers.

The pain, concentrated where the heel meets the arch of the foot, is worst in the morning because the ligaments tighten and fluid accumulates at the inflamed area while you sleep. It subsides after you walk around for a few minutes, but a dull ache usually returns later in the day, especially after you've been sitting or standing for a long time.

If left untreated, the symptoms can change, with the pain deepening and lasting beyond the morning. At that point, the condition morphs from acute inflammation to a chronic problem and from plantar fasciitis to plantar fasciosis, when scar tissue blocks the healing process.

It's best to treat plantar fasciitis at the first signs of pain, and a trip to the podiatrist is advisable to rule out other causes.

"It could be other things: It could be a stress fracture, a broken bone, a tumor, compression of a nerve or tarsal tunnel syndrome," said Neil Scheffler, president of the Baltimore Podiatry Group.

If it is plantar fasciitis, treatment options range from stretching to surgery. Reid said she always starts patients out with the most basic treatment: exercises to stretch out the Achilles tendon, which also stretches the plantar fascia; anti-inflammatory medications; and wearing shoes with a stiff heel. Inserting a heel cup into your shoes also helps.

While their heels are healing, patients shouldn't do any sports and should avoid sleeping on their stomach because it can cause the Achilles tendon to become tighter, Reid said. Scheffler said he advises his patients not to go barefoot at all, and to put running shoes on even to walk to the bathroom in the morning.

If that doesn't help, patients might wear a night splint to gently stretch their calf and Achilles tendon while they sleep, or custom orthotics to correct any biomechanical problems. Physical therapy also helps to get more blood to the tissue to promote healing.