Heel pain is most commonly caused by plantar fasciitis, which is the swelling of the tissue that connects the heel bone to the toes at the bottom part of the foot, also known as the plantar fascia.
Plantar fasciitis is often described as sharp pain in the middle of the heel, which is typically worse after periods of rest when fascia contracts. The pain usually becomes more bearable as the
muscles loosen up during the low-impact walking, but can return even worse after extended periods of walking or standing. The plantar fascia serves as a shock absorber and supports the footâs arch.
Too much tension on the plantar fascia can cause inflammation and swelling. Fortunately in most cases, plantar fasciitis treatment is fairly conservative. Plantar fasciitis exercises, medications and
orthotics are usually all thatâs needed to manage the pain. Most severe cases may require surgery.
Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen
if your feet roll inward too much when you walk ( excessive pronation ). You have high arches or flat feet. You walk, stand, or run for long periods of time, especially on hard surfaces. You are
overweight. You wear shoes that don't fit well or are worn out. You have tight Achilles tendons or calf muscles.
Plantar fasciitis is characterized by the following signs and symptoms. Acute plantar fasciitis, pain is usually worse in the morning but may improve when activity continues; if the plantar fasciitis
is severe, activity will exacerbate the pain, pain will worsen during the day and may radiate to calf or forefoot, pain may be described anywhere from "minor pulling" sensation, to "burning", or to
"knife-like", the plantar fascia may be taut or thickened, passive stretching of the plantar fascia or the patient standing on their toes may exacerbate symptoms, acute tenderness deep in the
heel-pad along the insertion of the plantar aponeurosis at the medial calcaneal tuberosity and along the length of the plantar fascia, may have localized swelling. Chronic plantar fasciitis, plantar
fasciitis is classified as "chronic" if it has not resolved after six months, pain occurs more distally along the aponeurosis and spreads into the Achilles tendon.
Your doctor can usually diagnose plantar fasciitis just by talking to you and examining your feet. Rarely, tests are needed if the diagnosis is uncertain or to rule out other possible causes of heel
pain. These can include X-rays of the heel or an ultrasound scan of the fascia. An ultrasound scan usually shows thickening and swelling of the fascia in plantar fasciitis.
Non Surgical Treatment
Over-the-counter Orthotics. A soft, over-the-counter orthotic (Prefabricated orthotic) with an accommodating arch support has proven to be quite helpful in the management of plantar fascia symptoms.
Studies demonstrate that it is NOT necessary to obtain a custom orthotic for the treatment of this problem. Comfort Shoes. Shoes with a stiff sole, rocker-bottom contour, and a comfortable leather
upper combined with an over-the-counter orthotic or a padded heel can be very helpful in the treatment of plantar fasciitis. Anti-Inflammatory Medication (NSAIDs): A short course of over-the-counter
anti-inflammatory medications may be helpful in managing plantar fasciitis symptoms providing the patient does not have any contra-indications such as a history of stomach ulcers. Activity
Modification Any activity that has recently been started, such as a new running routine or a new exercise at the gym that may have increased loading through the heel area, should be stopped on a
temporary basis until the symptoms have resolved. At that point, these activities can be gradually started again. Also, any activity changes (ex. sitting more) that will limit the amount of time a
patient is on their feet each day may be helpful. A night splint, which keeps the ankle in a neutral position (right angle) while the patient sleeps, can be very helpful in alleviating the
significant morning symptoms. A night splint may be prescribed by your physician. Alternatively, it can be ordered online or even obtained in some medical supply stores. This splint is worn nightly
for 1-3 weeks until the cycle of pain is broken. Furthermore, this splinting can be reinstituted for a short period of time is symptoms recur.
Surgery is considered only after 12 months of aggressive nonsurgical treatment. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles
place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches. In gastrocnemius recession, one of
the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope,
an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage.
Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is
partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an
open incision. In addition, endoscopy has a higher risk of nerve damage.