One morning about 10 years ago, Dr. Amanda Zeller Manley was running from the gym to catch a bus to work when she felt a snap. Her doctor later told her that the thick band of tissue on the underside of her foot that connects the heel to the toes, known as the plantar fascia, had nearly ruptured. “It was really painful,” says Zeller Manley, an optometrist in Chevy Chase, Maryland. To add insult to injury, she missed the bus.
It wasn’t the first time Zeller Manley had trouble with her foot, though it was the most severe. For years, she had dealt with heel pain, beginning with her first job as an optometrist, which required her to wear dress shoes, stand on hard floors most of the day and use equipment that was better adjusted for someone taller. “My very first job and it wrecked my foot,” laughs Zeller Manley, who lived in California at the time.
About 12 years ago, she was diagnosed with plantar fasciitis, a condition involving an inflamed plantar fascia that causes heel pain. People with plantar fasciitis tend to notice the problem when they wake up in the morning because their feet have tightened overnight, putting even more strain on the heel. “Ninety percent of the time … people will say, ‘I get out of bed in the morning, I can hardly put my foot down,'” says Dr. Jeffrey Ross, a podiatric surgeon and associate clinical professor at Baylor College of Medicine in Houston.
If not treated, scar tissue can develop, inhibit healing and lead to chronic plantar fasciitis. “It’s not going to go away,” says Dr. Howard Osterman, a podiatrist in the District of Columbia who treated Zeller Manley. “The problem is by ignoring it, you change the way that you walk and you create other issues. The earlier we treat heel pain, the better the chance we have of having it be an easy treatment.”
A Common Complaint
Plantar fasciitis affects about 10 percent of the population and accounts for about 1 million physician visits each year, Razdan says. The condition is known colloquially as “runner’s heel,” since it’s rampant among runners and other athletes who are constantly on their feet. It’s so common that nearly every Washington Wizards player has had it, says Osterman, the team’s podiatrist. “If everybody who had heel pain couldn’t play, we couldn’t field a team,” he says.
For athletes including dancers, marathoners and triathletes, the condition is often caused by overuse, says Dr. Rahul Razdan, an interventional radiologist in Lincoln, Nebraska, who frequently treats chronic cases of the injury. “[They’re] constantly trying to reach the next level” and don’t rest enough, he says.
Athletes can also be prone to plantar fasciitis if they outwear their shoes, sport poorly-fitted ones or — heaven forbid — try shoes like FiveFingers that mimic being barefoot, a trend that Osterman calls “one of the boons” to his practice.
But the condition is not limited to competitive athletes. In fact, “it’s probably just as common in non-runners as it is in runners,” says Osterman, who treats it more than anything else in his clinic, Foot and Ankle Specialists of the Mid-Atlantic. The condition can also be caused by a lifestyle or profession requiring lots of standing, shoes with poor support, a quirky foot shape such as being flat-footed or having high arches, or any combination of the above. People who are overweight or obese are also frequently diagnosed with plantar fasciitis since a foot strain can easily morph into the condition due to the added pressure on their feet, Osterman says.
Given America’s obesity epidemic, he says, “there’s going to be no shortage of heel pain we treat.”
Strides in Treatment
Zeller Manley had tried nearly all the typical first-line defenses to cope with her heel pain. In California, she worked with a podiatrist who encouraged stretching, which helped “a little,” she says. The same could be said for the orthotics she put in her shoes. She also tried to wear a boot at night for support, but she soon stopped because it was so hot and uncomfortable. The pain “was kind of waxing and waning,” she says, but never cured. Other noninvasive treatments include massage, physical therapy, stretching and even yoga, Ross says. He also advises his patients to regularly massage their heel with a frozen water bottle. Anti-inflammatory medications can help, too.
If those treatments don’t work, patients have several more intensive options. Zeller Manley knew it was time to explore them when she moved to the District and nearly ruptured her plantar fascia. Under Osterman’s care, she underwent a couple steroid injections, which can relieve pain and reduce swelling and some of the scar tissue, but don’t cure the problem. She also bought new orthotics to pad her shoes, but “it wasn’t enough,” Zeller Manley says.
Then she tried shockwave therapy, a new technique that uses sound waves to break down the scar tissue present in chronic fasciitis, Osterman says. For Zeller Manley, the one-time process took about a half-hour and, though painful, it “was the best thing I’ve ever done,” she says. The recovery was swift — Zeller Manley went to Las Vegas a few days later and walked everywhere — and she hasn’t had problem in that foot for more than five years.
Another similar therapy uses ultrasound imaging to target the scar tissue, break it up and “suck it up” through a thin needle, Razdan says. “We actually use image guidance to pinpoint the diseased tissue and take it out while leaving the healthy tissue alone.” Healthy tissue then grows in its place, says Razdan, who tested the technique on 100 patients in 2013 and found that 90 percent of them improved two weeks after treatment. Six months later, the patients were still doing well, had no related complications and reported being highly satisfied.
“If you got something that really works and helps people with a ubiquitous disease … and if it can get people back on their feet, or walking their dog or playing football or soccer with their kids,” Razdan says, “that’s a win.”
Another option for people with more severe plantar fasciitis is platelet-rich plasma therapy. The technique takes growth factors from the patient’s blood and injects them into the site of the injury to break down scar tissue and increase blood supply. Unlike cortisone injections, which can “stymie” healing, Ross says, PRP “jump-starts the healing process — it gets the body to heel itself.” Many professional athletes including Tiger Woods and Kobe Bryant have gone this route, Osterman says.
Such emerging procedures are promising alternatives to surgery, a last-resort option involving two incisions that release scar tissue and relieve the pressure. “We’re constantly coming up with new modalities,” from more advanced running shoe technology to holistic treatments like PRP, Osterman says. Still, he says, “there’s no substitute for maintaining your health and maintaining your flexibility.”
More from U.S. News
How to Know if You’re Exercising Too Much
10 Themed Races to Make Getting In Shape Fun
10 Epic Trails Almost Anyone Can Hike
How to Alleviate Heel Pain originally appeared on usnews.com
