Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

‍

Plantar fasciitis is a very common problem recognized by low-grade pain, in the beginning located on the sole of the foot just at the junction of the heel pad and arch and spreading to the arch of the foot. Pain may be felt immediately beneath the heel pad where the plantar fascia (a sheet of specialized fibrous connective tissue) inserts into the calcaneus bone, the principal bone of the heel. The inside of the heel may be more likely to cause pain than the outside. It is caused by microscopic tears and inflammation of the plantar fascia, which results from repeated bending of the foot in walking, excessive jogging, or running, especially when wearing shoes that do not protect from jarring. The injury may occur because the ankle is not flexible as it should be due to tightness in the calf, wearing high heels, sedentary lifestyle, etc. Swelling is not usually present, but tenderness is likely.

Plantar fasciitis is much more common in older people, as the footpad covering the heel tends to thin out more as one gets older. However, it can occur at almost any age. Being overweight increases the possibility of injury markedly.

If the condition has gone on very long, x-rays will often show a little "heel spur" or thickening where the connective tissue inserts into the bone on the heel. Previously, doctors thought that this was the problem and would operate to remove it, almost invariably causing more trouble than help. We now know that the spur is the result, rather than the cause of the pain and discomfort. We advise against surgery or cortisone injections, which may cause trouble. This condition can go on for months or years, if untreated.‍

‍

Treatment‍

1. Stretching the Achilles tendon is essential. Each day stand two feet from a wall. Support yourself with hands placed at shoulder height on the wall in front of you, lean into the wall, while keeping the heels flat on the floor. Hold the stretch about ten seconds, push away for five, and repeat three to six times at one session, and repeat approximately five sessions throughout the day.
2. HEET liniment, available at pharmacies, is effective. It contains cayenne extract, wintergreen and camphor. Take a Q-tip and moisten it in the HEET liniment; paint it all over the painful area (this will often extend up onto the instep). Then do the same with DMSO, available at health food stores. DMSO has the distinct property of facilitating entry of any substance on the skin surface through the skin into the deeper structures and circulation very rapidly. After the application the sole of the foot will often feel quite warm. That is normal. Do this twice daily until the pain goes away. One person reported relief of heel spur pain in two weeks by using the HEET-DMSO combination. Because the ointment can dry the skin out and cause flakiness, the use of a moisturizing lotion after the area has dried may be helpful. CAUTION! Always wash your hands thoroughly after using any cayenne preparation. It is easy to rub your eyes, and it will cause severe burning, if you do so.
3. If you cannot find the HEET liniment and cannot order it from your druggist, you can make a cayenne extract as follows: Put a half teaspoonful of ground cayenne pepper into three or four ounces of rubbing alcohol (the exact amount is not critical). Shake well in a bottle twice a day. It can be used right away, but please be persistent in using this combination, as it does not reach its peak potency, until about two weeks. At that time, if desired, it can be strained. Just use the alcohol; the ground can be discarded. (Straining is not necessary though, just to cut down on the staining of hosiery.) We have known of people who obtained relief from plantar fasciitis, using this remedy in as little as one week, but most will require several weeks, or even two or three months.
4. Some people prefer to take a small bottle and mix the DMSO and cayenne extract, about half and half. The mixture can be used on other painful joints or areas of the body, but elsewhere can be uncomfortable on the skin, and often the cayenne must be cut down markedly. If necessary, just the plain DMSO can be used on "tenderer" skin, as it is also anti-inflammatory. If the area itches severely, stop using it for a few days, rub on "vaseline milk" (take a small lump of vaseline; put in your palm and hold under running water; rub the hands vigorously under the tap, until the Vaseline becomes "milky" or emulsified, then spread on) or a good moisturizing cream spread over the area two or three times a day. You can start back with the cayenne alcohol, after the itching subsides, and it will often not bother the skin so much the following times.
5. Ice massage 20 minutes several times a day is a helpful remedy.
6. A prolonged firm massage of the area is also good—20-30 minutes.
7. Anti-inflammatory herbs, such as white willow bark and flax seed oil, may be tried.
8. Running or walking shoes with soft heels are recommended. Some have found relief from wearing hiking boots. Often well-fitted arch supports can be of value. A semi-rigid heel cup and a soft rubber pad in the shoe can be helpful.

Note: If the pain disappears, be sure to continue to wear the protective footwear, go on a weight loss program, continue the stretching exercises, and avoid jogging or other activities that would cause injury.

If you have access to ultra sound, a long treatment session, about 30 minutes in length, can be helpful for spurs.