Heel Pain (Plantar Fasciitis)
Because there are several potential causes, it is important to haveheel pain properly diagnosed. A foot and ankle surgeon is able todistinguish between all the possibilities and determine the underlyingsource of your heel pain.
What Is Plantar Fasciitis?
Plantarfasciitis is an inflammation of the band of tissue (the plantar fascia)that extends from the heel to the toes. In this condition, the fasciafirst becomes irritated and then inflamed, resulting in heel pain.
The most common cause of plantar fasciitis relatesto faulty structure of the foot. For example, people who have problemswith their arches, either overly flat feet or high-arched feet, aremore prone to developing plantar fasciitis.
Wearing non-supportive footwear on hard, flat surfaces puts abnormalstrain on the plantar fascia and can also lead to plantar fasciitis.This is particularly evident when one’s job requires long hours on thefeet. Obesity may also contribute to plantar fasciitis.
The symptoms of plantar fasciitis are:
- Pain on the bottom of the heel
- Pain that is usually worse upon arising
- Pain that increases over a period of months
People with plantar fasciitis often describe the pain as worse whenthey get up in the morning or after they’ve been sitting for longperiods of time. After a few minutes of walking the pain decreases,because walking stretches the fascia. For some people the pain subsidesbut returns after spending long periods of time on their feet.
To arrive at a diagnosis, the foot and anklesurgeon will obtain your medical history and examine your foot.Throughout this process the surgeon rules out all the possible causesfor your heel pain other than plantar fasciitis.
In addition, diagnostic imaging studies such as x-rays or otherimaging modalities may be used to distinguish the different types ofheel pain. Sometimes heel spurs are found in patients with plantarfasciitis, but these are rarely a source of pain. When they arepresent, the condition may be diagnosed as plantar fasciitis/heel spursyndrome.
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:
- Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
- Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
- Ice. Putting an ice pack on your heel for 20 minutesseveral times a day helps reduce inflammation. Place a thin towelbetween the ice and your heel; do not apply ice directly to the skin.
- Limit activities. Cut down on extended physical activities to give your heel a rest.
- 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), such as ibuprofen, may be recommended to reduce pain and inflammation.
If you still have pain after several weeks, see your foot and anklesurgeon, who may 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 fitinto your shoe help correct the underlying structural abnormalitiescausing 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 tomaintain an extended stretch of the plantar fascia while sleeping. Thismay 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 withplantar fasciitis respond to non-surgical treatment, a small percentageof patients may require surgery. If, after several months ofnon-surgical treatment, you continue to have heel pain, surgery will beconsidered. Your foot and ankle surgeon will discuss the surgicaloptions with you and determine which approach would be most beneficialfor you.
No matter what kind of treatment youundergo for plantar fasciitis, the underlying causes that led to thiscondition may remain. Therefore, you will need to continue withpreventive measures. Wearing supportive shoes, stretching, and usingcustom orthotic devices are the mainstay of long-term treatment forplantar fasciitis.