Heel Pain

Plantar Fasciitis (Heel Pain)

Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called Heel Spur Syndrome when a spur is present.  Heel pain may also be due to other causes, such as a stress fracture of the heel bone, tendonitis, arthritis, bursitis, nerve irritation, or a cyst.

Because there are several potential causes, it is important to have heel pain properly diagnosed.  At Professional Foot & Ankle Centers we are able to distinguish between all of the different possibilities and determine the underlying source of your heel pain.

What Is 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 first becomes irritated and then inflamed, resulting in heel pain.

Causes

The most common cause of plantar fasciitis relates to a faulty structure of the foot.  For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.

Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis.  This is particularly evident when one’s job requires long hours on the feet.  Obesity may also contribute to plantar fasciitis.

Symptoms

The symptoms of plantar fasciitis are:
    1.  Pain on the bottom of the heel
    2.  Pain in the arch of the foot
    3.  Pain that is usually worse upon arising
    4.  Pain that increases over a period of months

People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time and then first stand up.  After a few minutes of walking the pain decreases, because walking stretches the fascia.  For some people the pain subsides but returns after spending long periods of time on their feet.

Diagnosis

To arrive at a diagnosis, we will obtain your medical history and examine your foot.  Throughout this process we rule out all the possible causes for your heel pain other than plantar fasciitis.

In addition, diagnostic imaging studies such as x-rays or other imaging modalities 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.  When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Treatment

Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:
 1.  Exercises that stretch out the calf muscles help ease pain and assist with recovery.
 2.  When you walk without shoes, you put undue strain and stress on your plantar fascia.
 3.  Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. 
 4.  Cut down on extended physical activities to give your heel a rest.
 5.  Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the fascia.
 6.  Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used to reduce pain and inflammation.

If you still have pain after several weeks you need to visit Professional Foot & Ankle Centers for one or more of these treatment approaches:

1.  Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.

2.  In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.                                                          
3.  A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
              
4.  Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping.                                  
5.  Exercises and other physical therapy measures may be used to help provide relief.

When Is Surgery Needed?

Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery.   If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. 

Long-term Care

No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain.  Therefore, you will need to continue with preventive measures.  Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

Endoscopic Plantar Fasciotomy

If all conservative, non-surgical treatments have failed, then surgery may be indicated for you.  The EPF technique is a minimally invasive, endoscopic technique, which releases a portion of the tight plantar fascia.  There have been more than 1 million of these procedures performed since 1990, when the technique was developed.  This new method uses an endoscope, which is a small instrument that allows the surgeon to see "anatomy" inside the body-when used in joints, it is called an "arthroscope".  By using a very small incision, less than ½ inch, the new procedure releases the extreme tension on the plantar fascia which is the cause of the heel and arch pain.  All of this is viewed on the television monitor by the surgeon.  The procedure itself usually takes less than 10 minutes using a "twilight anesthesia" at a local surgery center or hospital.  A sterile dressing is worn for approximately 5 days and then the patient is usually allowed to return to regular shoe wear.  Minimal loss of work is incurred.