HEEL PAIN: Plantar Fasciitis  & Heel spurs

· Heel pain is most often caused by plantar fasciitis – a condition that is sometimes also called heel spur syndrome when a boney spur is present.

· Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, bursitis or, rarely, a cyst.

· Because there are several potential causes, it is important to have heel pain properly assessed by a Doctor of Podiatric Medicine. 

What Is Plantar Fasciitis?

    · Plantar fasciitis is an inflammation of the band of tissue (plantar fascia) that extends from the heel to the toes. The fascia becomes irritated & inflamed-resulting in heel pain.

   · When the foot flattens too much (called over-pronation), the plantar fascia over-stretches and develops small tears where it attaches to the heel bone. This tearing causes pain and bleeding inside the heel. The prolonged tension of the plantar fascia on the heel bone often results in the formation of a heel spur.

 

Symptoms of Plantar Fasciitis:

· Pain on the bottom of the heel

· Pain that increases over a period of months

· Pain that is usually worse upon arising in the morning.  The first few steps are often the worst.

· Pain returns after spending long periods of time on the feet

· Pain that radiates into the arch, side of the heel or up the back of the leg

Causes of Plantar Fasciitis

     · 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 lead to plantar fasciitis. This is particularly evident when a person’s job requires long hours on their feet.

 

     · 75% of people with heel pain are overweight. Being overweight places more tension on the plantar fascia.

Diagnosis

 

· x-rays, bone scans, or magnetic resonance imaging (MRI) may be used to distinguish the different types of heel pain, as well as your symptoms and pain in a specific area of your heel.  Most commonly this condition can be assessed throuugh the physical examination of your foot provided by your chiropodist or podiatrist

· Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain.  Rather, they are the after-effect.   

Treatment Options

· Custom Orthotics –Custom orthotics that fit into your shoe help correct the underlying structural abnormalities that cause plantar fasciitis.  They don’t just treat the symptoms!

· Shockwave therapy is now available at our office. High intensity sound waves target the plantar fascia and accelerate healing.  This treatment does not involve any incisions and has been shown to be effective in 84% of patients. Patients are permitted to walk immediately after the procedure.

· Activity Modification—avoid walking on hard surfaces such as cement or ceramic tiles.   Never walk barefoot, even indoors.

·  Rest – this gives your inflamed plantar fascia a well deserved break

· Stretching– should be done prior to getting out of bed in the morning. Your foot specialist can recommend specific exercises that can help you.

· Ice – massaging the painful heel reduces the pain of inflammation. Alternate with an ice bag on the heel for ten minutes on, ten minutes off.

· Support taping – your foot specialist can tape your foot to help support the arch and relieve stress on the fascia

· Medications – NSAIDS or  cortisone injections may be prescribed

· Physical therapy – ultrasound and phonophoresis to reduce pain and inflammation.

· Weight loss – weight loss can mean less pressure on the fascia, and less flattening out of the foot.

· Night splints allow you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.

· Removable walking cast boots may be used to keep your foot immobile for a few weeks to allow it to rest and heal.

 

 

 

 

 

 

 

 

Surgery

· In most cases, heel pain can be treated successfully with conservative methods.

· Occasionally, in cases where conventional methods have failed, surgery sometimes becomes necessary. This, however, is the exception, rather than the rule.

· As a last resort a surgical procedure involving one tiny incision is made at the inside of your heel and the tight plantar fascia band is released.  This reduces tension on the band and is effective for the vast majority of patients.  Patients can walk immediately after the surgery in a special shoe.

· Heel spur surgery is a thing of the past and not really performed any longer since research has shown that the cause of heel pain is a tight & inflamed plantar fascia along with faulty foot mechanics and not the heel spur itself.