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What is the Intense Pain in your Heel?

Treatment of the Policeman's HeelA high probability is that the stabbing pain you are feeling or have felt in the heel of your foot is called Plantar Faciitis (PF). The condition is typically characterized as intense stabbing pain in the heel, especially on awakening and beginning your day. But guess what? It can occur after any period of physical activity. I don’t know about you, but neither of these timeframes-to experience intense pain in my heel-is optimal for me.

I think back to my own first episode of PF every time I try to provide relief for the unlucky client who is experiencing this menacing condition, which can be short-term or chronic. But even if short-term, there is nothing ‘short’ about it in terms of the pain level and dysfunction it can cause. Sadly, by the time the client comes into the massage center with PF, we see a hobbling body accompanied by a grimacing face.

What is the medical definition of PF and what causes it? It is an inflammatory process of the connective tissue (fascia) on the bottom surface of the foot (plantar). It is often caused by overuse of the plantar fascia or arch tendon and is surprisingly common, affecting over two million Americans every year. I had no idea how common PF is until I became a massage therapist. And when I experienced it myself, I learned how difficult it can be to treat if preventive or corrective therapies, such as arch supports, ultrasound, massage, and stretching, are not applied. For a barefoot kind of gal, this was an awakening for me.

How does the process of PF start? It is associated with long periods of weight bearing; thus the nick-name: ‘Policeman’s Heel.’ In non-athletic populations, it is associated with a high body mass index, but many whom we treat are at a healthy weight and often, thin.
Pain is usually felt on the underside of the heel. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). Frequently there are complaints of associated knee pain, especially among walkers and runners.

Think of plantar fascia as your body’s shock absorber. Throughout the day, the fascia supports the arch of your foot to carry the weight of your body. When any impact is too great, tiny tears will appear in the fascia. If the impact level continues, the tears become inflamed. Eventually the excessive wear to the fascia causes the inward rotation of your foot. Wearing unsupportive footwear (who, me?), obesity, inactivity, poor weight distribution due to faulty foot mechanics, or sudden changes in weight distribution (in my case, racquet ball) are all contributors.

What can happen if PF is not treated? Chronic degeneration can develop which then becomes Plantar Fasciosis. ‘Osis’ implies a pathology of longstanding degenerative changes without inflammation. A host of new issues can develop as your body mechanics try to adjust for the foot pain. Chronic knee, hip, and back pain are common complaints.

The good news is that noninvasive treatment is available. Most treatment plans focus on having you temporarily avoid the activity that caused the inflammation. Yes, I know this part of the plan is difficult for many of you, but it is a necessary part of the healing process.

Your feet serve as your physical foundation! If you think you have Plantar Fasciitis, a consultation with your primary care physician or podiatrist will provide the diagnosis and a good start to recovery. For a good finish, come see us or visit a massage therapist in your area soon.

Nancy Shores, LMT

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