It is 6:30 am and your alarm goes off. You turn over in bed, remove the sheets and climb out of bed to start a new day. Your feet hit the floor and all of a sudden you know something is wrong. The pain in your heel almost causes you to buckle and fall to the floor. You grab on to the dresser and hobble to the bathroom. You think, "this pain is unbearable!" In the shower you stretch and loosen up and by the time you emerge, the pain has diminished, but only a bit. The pain is a little more manageable and you limp to the closet and change into your clothes. Somehow it seems to work itself out and you make it to your car. By the time you arrive at work it is only a dull ache, but it returns with a vengeance by the end of the day.

Sound familiar? If this scenario is one you are living with, then there is a high probability you have plantar fasciitis, one of the most common causes of heel pain. This problem is a result of excess stress through a long ligament type structure (the plantar fascia) in the bottom of the foot. The excess stress causes tearing and results in inflammation and pain. The classic symptoms are pain in the heel at the first step in the morning, or upon rising after long periods of rest. Many will complain of a sharp pain in the heel when they step out of their car or after finishing their lunch break. Others with plantar fasciitis rarely have morning pain and only experience the pain during certain types of activity like running or climbing up and down stairs.

The most common type of pain is a sharp pain in the bottom of the heel. The pain is sometimes described as burning and sometimes as radiating, but many times it is described as a "stone bruise". The pain may extend into the arch and at the end of the day many will complain of throbbing in the heel.

One of the most common reasons for the development of plantar fasciitis is wearing poor quality or worn out shoes. When a shoe is unable to support the foot properly, undue stress is placed on the arch and the fascia responds by tearing. When a poor pair of shoes is coupled with a new activity, such as walking or running, the chances of developing plantar fasciitis increases substantially. Individuals with flatfeet or excess pronation (rolling in of the feet) may have a natural predisposition for plantar fasciitis. Just because an individual has flatfeet doesn't mean he or she will develop fasciitis. All types of feet can develop fasciitis, even those with high arches. Regardless of how or why the problem started, or what type of foot the person has, plantar fasciitis is difficult to treat and symptoms may be present for up to 12 months. Treatment is aimed at decreasing the stress on the arch and decreasing the inflammation in the fascia.

1. Identify the cause: the condition is not typically associated with an acute injury, but you should examine your shoes and try to think of any changes in activity you may have had. 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.

2. Stretch! Stretch! Stretch! Stretch your calf in the morning: If you have pain in the morning upon waking, wrap a towel or a belt around the ball of your foot, before you get out of bed. 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 fascia. If this helps, consider getting a night splint. This will help stretch the fascia all night long.

3. Continue stretching throughout the day. I recommend stretching the calf and arch at least once every hour for 30 seconds. Place your foot against the wall or a step and push your heel down and keep your knee straight. You should feel the stretch in your calf.

4. Use an ice massage: Freeze a sports water bottle 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.

5. Use a contrast bath: 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.

6. Stop the aggravating activities: Stop running or exercise walking. These activities will put a substantial amount of pressure on the fascia. Take a break and do some cross training, by biking or swimming. Limit 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 your own stairs and avoiding walking up and down hills.

7. 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 can be done while watching TV or reading the paper. Rolling the foot over the tennis ball can also be done at work if you have a desk job or during a lunch break. (This should not cause pain. Don't continue if you have pain).

8. Wear supportive shoes: 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 folds in half, throw it away and buy a supportive shoe. Don't go barefoot. Get up in the morning, perform a calf stretch for 30-60 seconds and then slip your feet in a supportive slipper or clog. See the American Podiatric Medical Association's (APMA) list of approved shoes at www.apma.org/ seal/sealaccategory.html.

9. 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 will decrease the stress on the plantar fascia. Soft inserts available at the drug store may be comfortable, but they will not help control abnormal motion. A very soft and cushy insert may cause more problems than it will solve. I recommend a sports orthotic, for example Superfeet, which are available online or at your local sports store.

10. See a podiatrist. If your symptoms persist, don't delay. Make an appointment with a podiatrist.