Heel pain is one of the most common diagnosis that we see in our practice. Heel pain is often due to an inflamed ligament on the bottom of the foot called the plantar fascia. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst.
Because there are several potential causes, it is important to have heel pain properly diagnosed. As foot specialists we are able to distinguish between all the 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.
The most common cause of plantar fasciitis relates to 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 typically found when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.
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. 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.
To diagnose the type of heel pain that you suffer from our staff will obtain your medical history and examine your foot. Throughout this process our foot specialists will 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.
- Stretching exercises
- Avoid going barefoot
- Limit activities
- Shoe modifications
If you still have pain after several weeks, our foot specialists, will add one or more of these treatment approaches:
- Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia
- Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis
- Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain
- Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal
- Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients
- Physical therapy. 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. Our foot specialists will discuss the surgical options with you and determine which approach would be most beneficial for you.
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.