Dr. Berg's Foot Facts

Posts for: July, 2018

By Dr. Rion Berg
July 26, 2018
Category: Heel pain
Tags: plantar fasciitis  

As a Seattle hiker every year you look forward to summer. You know there's nothing like putting on your backpack, leaving the city behind, and taking in the wonders of the forest and the mountains.

That's why when you're having heel pain the idea of not being able to hike is so distressing. I've put together this definite guide for hikers prone to heel pain to empower you to prevent this condition from reoccurring.

What Causes Heel Pain?

Most heel pain is diagnosed as plantar fasciitis so for the remainder of this guide I'll use the term heel pain and plantar fasciitis interchangeably. Any discussion of preventing plantar fasciitis must begin by understanding its cause. Let's start with a description of your foot and calf anatomy.

The foot has a long band of tissue that originates at the heel, travels across the arch, and connects at the base of the toes called the plantar fascia. This structure helps support the arch and your body weight as you hike. The Achilles tendon is connected to the bottom of your heel and to your calf muscle. Tightness in the calf muscle can strain your Achilles tendon and your plantar fascia.

Heel pain is caused by an inflammation of the plantar fascia. The inflammation develops as the result of stress on this tissue causing micro-tears at the bottom of the heel where it inserts. It's brought on by a combination of repetitive strain on the tissue, faulty biomechanics of the foot, and tight calf muscles.

Hiking is an activity that can cause the plantar fascia to become inflamed due to its repetitive nature and the added weight of carrying a backpack.

If you're a hiker with faulty foot mechanics (i.e. flat feet) you're more at risk for developing plantar fasciitis. Why? People with flat feet tend to over pronate or roll their feet inward which pulls on the plantar fascia.

In addition, if you also have tight calf muscles this will put even more strain on the plantar fascia.

What Hikers Can Do to Prevent Plantar Fasciitis

As a Seattle podiatrist there's a lot I can do in my office to help alleviate your heel pain and prevent it from reoccurring. However, there's also a lot you can do to keep it at bay.

Shoes and Boots
One of the most important things you can do to prevent heel pain is to ensure you have hiking shoes or boots that provide the support and stability you need for the type of trails you hike on.

1. Assess the type of hiking you'll be doing before purchasing your shoes or boots. A lightweight hiking shoe may be perfect for an easy hike like Lake 22 in the Cascades but a heavy duty hiking boot will be needed for hikes with more elevation gain and rougher terrain.

2. Your shoes or boots should fit snugly but not too tightly and provide enough room in your toes so that you have wiggle room. Make sure to have your feet measured when purchasing your footwear.

3. Take your foot type into account when purchasing shoes or boots. For example, if you have flat feet shoes and boots with good arch support are a must.

4. Shop for shoes toward the late afternoon when feet tend to swell.

5. Purchase socks at the same time you purchase boots to ensure a good fit. Here's information about the best socks for hikers.

6. Try different lacing techniques to ensure a proper fit.

7. Make sure you break in new boots before you go hiking. While hiking shoes won't need break-in time, leather boots will.

8. Don't attempt to buy boots online unless you've had experience with a particular brand and size. Go to a reputable store like REI and work with their boot experts.

Replace Your Insoles
Most shoes and boots have insoles that aren't supportive enough to prevent you from pronating and developing plantar fasciitis. Buy a high volume insole for a boot and a medium volume insole for a lightweight hiking shoe. Superfeet makes insoles specifically for hiking boots called Trailblazers. Regular Superfeet or another insole called Powersteps can be used in hiking shoes.

Increase Your Hiking Distance and Level of Difficulty Gradually
Since plantar fasciitis is a repetitive strain injury, it's important to build up to longer and more difficult hikes slowly. Your body needs time to adjust and will serve you much better if you take it easy at the start of hiking season.

Warm-ups and Stretching
While doing warm-ups and stretching is important for all hikers it's particularly important if you're prone to developing plantar fasciitis. Calf muscles can tighten up after sitting in a car for longer than an hour. At the very least perform the traditional standing calf stretch against a tree or even your car by putting one foot forward and then stepping back with the other foot. Place most of your weight on your back foot and slowly lean into the tree or car until you feel a stretch at the back of your calf. Hold for 30 secs to one minute.

Another type of stretch that will give you more benefit is a dynamic stretch. Here are some dynamic stretches for hikers.

Avoid Going Barefoot
If you have a tendency toward getting heel pain, it's important that you avoid going barefoot even when you're at home. We recommend sandals by Vionic or another pair of sandals that provide arch support.

Weight Loss
Overweight hikers are also more at risk for developing plantar fasciitis. Even losing five pounds can make a big different in the amount of pressure you put on your feet and may help prevent plantar fasciitis.

Self-Treatment for Hikers with Mild Plantar Fasciitis

For mild heel pain you'll very likely need to stop hiking until the pain goes away. Unfortunately with every step you take your re-injurying your plantar fascia. To prevent it from getting worse it's important to stop the inflammation from occurring.

However, there are some specific things you can do to help reduce your inflammation and help your feet heal more rapidly.

1. Icing
Icing is one of the most important things you can do to reduce inflammation (swelling) and pain. You can begin doing this before you come in to see a podiatrist. It's extremely important to ice your heels after hiking if you plan to continue doing so.

There are two methods you can use to ice your heel.

  • Ice cup massage- fill a Dixie cup ¾ full of water and freeze. Peel the top down so that about .5 inches is showing so you can easily massage the affected area while holding onto the cup. Ice for about 7-10 minutes three times a day.

  • Use frozen peas as a cold pack- frozen peas are inexpensive and conform to your foot.

2. Heel lifts
Heel lifts may be a good initial solution. Heel lifts raise the heel in the shoe decreasing the Achilles tightness by effectively shortening it.

3. Biofreeze
Biofreeze can provide temporary relief of heel pain.

4. Anti-inflammatory medication
Anti-inflammatory medication acts to reduce pain and swelling.

In addition, it's important to follow all the recommendations for preventing heel pain to help reduce your current heel pain.

Treatment for Hikers with Moderate to Severe Pain Plantar Fasciitis
For pain that's more than mild, you should make an appointment with a podiatrist to get properly evaluated. In addition to the inflammation reducing methods described above, at the Foot and Ankle Center of Lake City we provide the following services to treat mild to severe plantar fasciitis.

1. Custom Orthotics
Even though over-the-counter insoles can work well for mild heel pain, you'll likely need custom orthotics for moderate to severe heel pain. Custom orthotics provide the highest degree of support, controlling abnormal motion in the foot and helping with postural alignment. Depending on how much you hike, prescriptive orthotics can last from 3-7 years. Your foot is scanned in our office and then orthotics are made by a professional orthotics lab. When you return to our office the orthotics are adjusted to fit your feet.

2. Low Dye Taping
Low dye taping is typically used during your first visit to our office. People often feel immediate pain relief because the tape prevents your plantar fascia from pulling when stepping on the ground. The tape usually lasts about three days if covered when showering. To continue to tape your feet until you receive orthotics our office has tape that can be easily applied at home.

3. Use of a walking boot or AirHeel device
Both of these products will reduce direct pressure on the affected area and allow healing to begin.

4. Cortisone injections for acute pain
For patients in extreme pain or who are taking a trip and don't have time to have other treatments, cortisone shots in the heel can reduce inflammation quickly. This is only a short term solution.

5. Using a splint
As mentioned earlier, tight calf muscles are often part of the reason people who hike develop plantar fasciitis. Although the methods for stretching described earlier work well to prevent plantar fasciitis, once you have the condition using a splint provides the additional time needed to more fully stretch the calf muscle. The splint is used during the day for 20-30 minutes on each side while watching TV or reading. This video explains how the splint is used.





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