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.
The cause of plantar fasciitis is poorly understood and is thought to likely have several contributing factors. The plantar fascia is a thick fibrous band of connective tissue that originates from
the medial tubercle and anterior aspect of the heel bone. From there, the fascia extends along the sole of the foot before inserting at the base of the toes, and supports the arch of the foot.
Originally, plantar fasciitis was believed to be an inflammatory condition of the plantar fascia. However, within the last decade, studies have observed microscopic anatomical changes indicating that
plantar fasciitis is actually due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process. Due to this shift in thought about the underlying mechanisms in
plantar fasciitis, many in the academic community have stated the condition should be renamed plantar fasciosis. The structural breakdown of the plantar fascia is believed to be the result of
repetitive microtrauma (small tears). Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers.
Disruptions in the plantar fasciaâs normal mechanical movement during standing and walking (known as the Windlass mechanism) are thought to contribute to the development of plantar fasciitis by
placing excess strain on the calcaneal tuberosity.
Symptoms of plantar fasciitis can occur suddenly or gradually. When they occur suddenly, there is usually intense heel pain on taking the first morning steps, known as first-step pain. This heel pain
will often subside as you begin to walk around, but it may return in the late afternoon or evening. When symptoms occur gradually, a more long-lasting form of heel pain will cause you to shorten your
stride while running or walking. You also may shift your weight toward the front of the foot, away from the heel.
During the physical exam, your doctor checks for points of tenderness in your foot. The location of your pain can help determine its cause. Usually no tests are necessary. The diagnosis is made based
on the history and physical examination. Occasionally your doctor may suggest an X-ray or magnetic resonance imaging (MRI) to make sure your pain isn't being caused by another problem, such as a
stress fracture or a pinched nerve. Sometimes an X-ray shows a spur of bone projecting forward from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed
surgically. But many people who have bone spurs on their heels have no heel pain.
Non Surgical Treatment
Many cases of plantar fasciitis can be treated with simple, conservative measures. These include ice packs, stretching exercises, anti-inflammatory medications, orthotic devices (custom molded
orthotics), and physical therapy. Itâs important to consult your doctor before you take any medications to treat this condition. In chronic or persistent cases, one of three techniques may be used
to treat plantar fasciitis. Extracorporeal Shock Wave Treatment (ESWT). TOPAZ treatment. Platelet Rich P
When more-conservative measures aren't working, your doctor might recommend steroid shots. Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple
injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. Extracorporeal shock wave therapy.
In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more-conservative treatments. This
procedure may cause bruises, swelling, pain, numbness or tingling and has not been shown to be consistently effective. Surgery. Few people need surgery to detach the plantar fascia from the heel
bone. It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.