Heel Pain
Heel pain can often be caused by plantar fasciitis, a condition that is can also be called heel spur syndrome when a spur is present.
It is important to know that the pain is not caused by the spur itself but rather the band of tissue attached to the heel. Due to the tightness of the plantar fascia the spur continues to increase in size as bone models and forms to the increasing forces that are applied.
Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation or, rarely, a bone cyst.
Plantar Fasciitis
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia becomes irritated then later inflamed. At times repetitive activity of the band of tissue without stability/support causes overuse. This activity puts stress on the band of tissue leading to micro-injury of the fibers. Because of the ongoing stress on the fibers, the body is unable to repair the injured tissue.
Causes
The most common cause of plantar fasciitis relates to poor/faulty structure of the foot. Patients who have problems with their arches (flat feet or high-arched feet), are more prone to developing plantar fasciitis.
Non supportive footwear on hard, flat surfaces puts strain on the plantar fascia and can also lead to plantar fasciitis. This occurs when patients job or activities require long hours on the feet. Obesity and overuse may also contribute to plantar fasciitis.
Symptoms
- Pain on the bottom of the heel.
- Pain in the arch of the foot.
- Pain appears when getting up in the morning or after periods of rest (post-static dyskinesia), and can improve somewhat with motion but then worsens towards the end of the day or with increased activity.
- Pain that increases over a period of months.
- Swelling on the bottom of the heel.
Diagnosis
In diagnosing heel pain; range of motion and the condition of the band of tissue will be evaluated as well as the surgeon gently pressing on areas of the fasica/calcaneus (heel bone) to determine the area of discomfort. The extent of the condition can be further assessed with x-rays or other imaging modalities.
X-rays or other imaging modalities (i.e. MRI, Ultrasound) may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain.
Non Surgical Treatments
Treatment approaches for plantar fasciitis are based on how long the pathology has been present and the amount of damage to the band of tissue. Conservative treatment options are encouraged prior to surgical intervention.
- Stretching exercises. Exercises that stretch out the calf muscles help ease pain of the plantar fascia as a small band of tissue connects the achilles and the plantar fascia
- Avoid barefoot. When you walk without shoes, you put increase strain and stress on your plantar fascia.
- Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin. At times you can freeze a water bottle and roll your arch back and forth over the frozen water bottle.
- Limit activities. Reduce extended physical activities.
- Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.
- Orthotic devices. Custom devices that fit into your shoe help correct the underlying structure of the foot and stabilize the arch.
- Shoe modification. Shoes that have a rigid or semi-rigid sole help support the plantar fascia.
- Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
- Removable walking boot. A removable walking boot may be offered if the pain is severe to allow the plantar fascia to rest and heal.
- Night splint. A night splint may be prescribed to you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain.
- Exercises. Stretching exercises help relieve tension from the Achilles tendon.
- Physical therapy. Physical therapy may include strengthening exercises, soft-tissue massage, mobilization, ambulation education, stretching, and ultrasound therapy to reduce inflammation.
Surgery
Although most patients with plantar fasciitis respond successfully to non surgical treatment, a percentage of patients may require surgery. After several months of nonsurgical treatment with persistent heel pain surgery will be considered. Your surgeon will select the best procedure to release the pathology of the plantar fasciitis and/or remove the heel spur depending on the size. At times the heel spur will resolve over time once the plantar fascia is released.
Surgery is typically an outpatient procedure (day surgery) and scheduled at your convenience.
A splint or boot will be placed on your surgical foot/ankle after surgery. Limited weight bearing is encouraged to allow the incision to heel during the first 2 weeks. Do not begin full weight bearing until advised by your Surgeon.