Q: I am a 33 years old man having calcaneal spur on the heel. It pains whenever I walk and I cannot keep my foot down when I wake up. The physiotherapist suggested an ultrasound, which I am not very clear about. I am already wearing MCR insole into my shoes. Please suggest some cure, precautions or therapy for this problem?

A:To deal with any kind of heel pain there are few points to care of. Regardless of how the problem started, the treatment is aimed at decreasing the stress on the arch and decreasing the inflammation.

• Identify the cause: There is usually a reason for the development of plantar fascitis, but since the condition is not typically associated with an acute injury it may be hard to remember. The pain may have gradually developed after starting a new training routine, changing the routine, running or walking on a new surface, switching shoes, wearing worn out shoes or starting a new job. Once the cause is identified, stop the activity or modify it.
• Avoid aggravating activities: Going up and down stairs, walking or running on hills, squatting, lifting heavy items and walking on uneven terrain all aggravate this condition. Try to decrease these by limiting the number of times you go up and down the stairs and avoiding hills. If you must squat down, keep the affected foot in front and flat on the ground. Do not lift or carry heavy items.
• Stop running or walking: Aerobic activity is important to maintain and cross training can help. Try biking or swimming. Most walkers hate the stationary bike at the gym, but remember this isn't forever. Don't drop your heel when you bike and try to avoid standing and hills if you cycle outdoors. The recumbent stationary bike may place excess stress through the arch because of the position. The classic stationary bike is more appropriate.
• Use an ice massage: Freeze a sports water bottle or a juice can and place it on the floor. Roll your foot over the water bottle for at least 20 minutes twice a day. This helps decrease the inflammation in the foot while stretching out the arch.
• Use a contrast bath: Icing helps decrease inflammation occurring within a 48-72 hour period. To help decrease chronic inflammation, try contrasting between ice and heat. Start with an ice pack on the heel and/or arch for 5 minutes. Switch to a heating pack or a hot water bath for 5 minutes. Alternate between the two for 20- 30 minutes 3-4 times a week. This may be more time consuming than the ice pack alone, but can bring considerable relief.
• Roll a ball under your foot: Take a tennis ball, soft ball or even a rolling pin and roll your foot over it to help stretch out the plantar fascia. (This should not cause pain. Don't continue if you have pain).
• Stretch your calf in the morning: If you have pain in the morning upon waking, place a towel or a belt on your dresser. Before you get out of bed, wrap the towel or belt around the ball of your foot. By pulling the foot towards you and keeping your leg straight, you should feel a stretch in the back of the calf. This will also stretch the bottom of the foot.
• Ultrasound therapy for few days will help reducing the inflammation. Also faradic footbath can do wonders for heel pain because of any reason.
• Lose Weight: There is a good chance that you have gained some weight since the onset of your heel pain due to a decrease in activity. But, there is no way around the fact that increased weight on the body transmits to the feet. Increasing the stress on the plantar fascia can worsen plantar fasciitis, making it more difficult to treat.
• Wear supportive shoes: This step may seem logical, but most individuals don’t realize how many shoes lack support. A supportive shoe will only bend at the toes. Test all of your shoes and don’t assume your running shoe is a supportive shoe. Take your shoe and flip it over. Grab the toe area and the heel and try to fold the shoe. If the shoe bends in half, then the shoe is not supportive. Don't go barefoot. Get up in the morning, do your stretch and then slip your feet in a supportive slipper or clog.
• Strengthen the muscles in your feet: Place a thin towel on your kitchen floor. Place your foot over the base of the towel closest to you. Bring the towel towards you by curling the toes and gripping the towel as it slides under your foot. Place marbles on the floor and pick them up one by one with your toes and place them in a bowl. Also ask your physiotherapist to show some intrinsic muscle strengthening exercises to you.
• Wear orthotics: Prefabricated orthotics are semi-rigid inserts that fit into the shoe to help control motion in your feet. Controlling abnormal motion in the feet can decrease the stress in the plantar fascia. Soft inserts available at the drug store may be comfortable, but they will not help control abnormal motion.
• Try a night splint: A night splint holds the foot at 90 degrees while you sleep. This keeps the foot and the calf stretched out all night long. Night splints are an effective treatment, but can be quite uncomfortable. Some individuals have more luck with the sock night splints than with the rigid splints.