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Heal the Heel
by Ali Javanbakht, MD 05-17-2012

Another school year has come and gone. Here we stand on the precipice of shoving another cohort of youth out into the “real world.” But first, they must walk. They must walk from the gym to the football field, from the football field to their seats, from their seats up onto the stage where they receive a scroll that tells them they will receive their real diploma later. Then they walk back to their seats. After a short sit, they walk around greeting each other while trying to fit in photos with those pesky, tearful parents who won’t leave them alone. The moral of the story is that graduation involves a lot of walking.

This makes it a great time to talk about conditions that make it difficult to walk, such as incorrect glasses, the glance of a beloved, and plantar fasciitis. The first is easy enough to correct but the latter two can be nagging injuries.

Since no one in the entire 6,000 years of recorded human history has been able to come up with a solution for the neural disruption brought about by the glance of a beloved, this article will be about plantar fasciitis.

To understand plantar fasciitis, let’s first look at its definition. “Plantar” means the bottom of the foot. (The condition could have been called “sole fasciitis” but it sounded too much like a funk fusion band. Besides, there is an unwritten requirement that all medical terminology carry a certain gravitas so providers can say them while appearing deep in thought. Somehow Hoppe-Goldflam Syndrome slipped through the cracks. That’s why the name was later changed to myasthenia gravis. We thought briefly about calling it myasthenia gravitas but that seemed like overkill. But I digress.)

“Fascia” is a thin membrane in the body that covers things. And “-itis”, as mentioned in previous articles, means inflammation. So putting them all together, we get “inflammation of the thin membrane covering the bottom of the foot.”

The plantar fascia looks like a partially opened fan. The wide part attaches to the base of the toes and the point attaches at the heel. Sometimes, for various reasons, the point of attachment to the heel gets inflamed. This is typically caused by “overuse” which, in the case of the heel, means a lot of walking, standing or running. But it can also be caused by regular daily activities over time.

When the attachment of the plantar fascia into the heel gets inflamed, it causes pain. The pain is less when sitting or lying down since there isn’t a lot of tension or pressure on the plantar fascia. But when the patient stands up, or first gets out of bed in the morning, placing the foot on the ground stretches the plantar fascia and causes sharp pain.

Treatment of plantar fasciitis involves heel inserts, arch support inserts, stretching and strengthening exercises, and anti-inflammatories. Physical therapy can also be helpful. If the above fails, sometimes steroids are injected into the area.

So to all graduating seniors, best of luck out there. If you’re having sharp heel pains when you go to stand up after your name is called, it might be plantar fasciitis. By the looks of the job market, there might be plenty more walking in your future, so it might be worthwhile to get the plantar fasciitis addressed. However, if you get a sharp pain in your gut after standing, it might be the nacho cheese sauce from Grad Night, all the sit ups you did in anticipation of swimsuit season, or it might be the glance of a beloved. The former two are easily treated by avoiding the offending food and gentle stretching. But as for the third . . . .alas!