I had an interesting conversation with a patient this morning about plantar fasciitis. The patient had classic signs of plantar fasciitis that included pain upon initial weight bearing and relief of pain with rest. In her research on the Internet, she had found that most informational sources stressed support of the arch with an arch support. “I was ready to spend over a hundred dollars at a foot care web site but thought I better check with you first.” And I think my patient was very surprised to hear from me that plantar fasciitis had nothing to do with arch support. It has everything to do with the height of the heel.
In part one of this series on heel lifts, we talked a bit about the mechanical forces that are generated by the calf and how those forces are distributed in the foot. A fine balance exists in the leg, ankle and foot that performs well in young patients, but tends to develop problems as we age. You see, the calf generates force with each step that we take. In optimal biomechanics, that force is distributed to the foot in a way that lifts the body and enables forward motion. But as we age, we start to loose tissue elasticity. We still have the strength to perform the activities that we want to, but we lack the elasticity to heal. And that’s what’s at the heart of what causes plantar fasciitis. Essentially, the strength of the calf overwhelms the ability of the fascia to heal.
And what about the humble heel lift? A heel lift is used to treat plantar fasciitis in a somewhat indirect manner. By elevating the heel, you’re weakening the force generated by the calf. Decreasing the force delivered by the calf to the foot decreases the load applied to the fascia and enables the ability of the fascia to heal. It’s pretty simple really, raise the heel and the plantar fasciitis will get better. Lower the heel (barefoot, low heeled shoes) and the plantar fasciitis gets worse.
So I ask you, if you had plantar fasciitis and were looking for cost effective treatment which would you choose; an Rx orthotic at $250(+)/pair or a heel lift at $3.95/pair. And that’s the point in our conversation that my patient said to me, “man, am I glad I stopped to see you first.”
Treatment of plantar fasciitis doesn’t have to be complicated. And it’s important to recognize that not all patients will be pain free with the use of a heel lift. But in my experience, 7/10 are at least 50% improved within 3 weeks. Not a bad success rate for the humble little heel lift.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
