Heel Pain

Heel pain is one of the most common mechanical foot ailments. There are many causes of heel pain but the most common cause is plantar fasciitis.

What is plantar fasciitis?

Plantar fasciitis (pronounced PLAN-tar fashee-EYE-tis) is the most common cause of heel pain a localized inflammation of the plantar fascia. Patients with plantar fasciitis describe an ache localized to the inside part of the heel. Other descriptions are tugging, pulling and burning. The pain can range from mild to severe and can interfere with activities. The typical clinical presentation is pain after rest most notably occuring with the first few steps in the morning and toward the end of the day, especially if was lots of walking or standing.

What is the plantar fascia and how does it become inflammed?

The plantar fascia is a long arch supporting structure that resembles a ligament. It attaches to the bottom of the heel bone (calcaneus) traverses the arch, and attaches to tissue at the base of the toes, thereby functioning as a major support for the arch of the foot. The structure is susceptible to overuse injury that leads to localized inflammation at the heel and thickening of the fascia. The condition then tends to linger because normal activities can perpetuate the inflammation and delay healing.

Are some people more susceptible in getting the condition?

Biomechanical factors may be involved and can magnify the stress and strain placed on the plantar fascia, making an individual more susceptible to developing plantar fasciitis. In these cases, biomechanical factors such as foot pronation (arch collapse), excessive weight, and calf muscle tightness (equinus) need to be addressed or negated.

What is the quickest cure for the problem?

The treatment of plantar fasciitis is a process. There are no quick cures for immediate relief that are permanent. To achieve resolution of symptoms, there needs to be steady improvement of symptom intensity with near 90 percent resolution of pain for at least 3 months. In order to cure the condition, which can take 3-12 months, it is imperative to control the symptoms and change the mechanical environment to which the foot is exposed.

Patient Directed Care

The following recommended treatments which you can start on your own, will often resolve mild cases of plantar fasciitis.

  • Weight loss
  • Use of stiffer more supportive shoes
  • Avoid barefoot walking or walking in non-supportive slippers or sandals
  • Add an over-the-counter arch support to your shoes (use of heel pads rarely helps).
  • Perform calf stretching 2-3 times per day (see exercise section on web site)
  • Modify activities to walk less and avoid impact activities
  • Ice the heel at end of the day or shift for 15 minutes (ice massage preferred). Caution do not ice if you have circulatory or sensory deficits to your lower extremities.
  • Consider use of over-the-counter anti-inflammatories (Caution: as long as there are no medical conditions that prevent use (i.e. stomach ulcers, kidney disease, bleeding disorders, already on prescription antiinflammatory, or other blood thinners like Plavix or Coumadin, or allergies or other adverse reactions).
  • Note: recommend formal treatment and medical evaluation if you have not responded to self directed care within 8 weeks.

Clinic Treatments:

There are additional treatment that the doctors at Ankle & Foot Clinic of Everett will suggest in addition to your self-directed treatments.

  • Cortisone injections: A powerful tool to significantly reduce inflammation at the heel (Other treatments need to be in place to get maximum benefit from these injections).
  • Physical therapy referral
  • Use of night splint
  • Cast immobilization
  • Custom Orthotics
  • Serial taping
  • Surgery (rarely indicated)

Other Types of Heel Pain:

There are many other forms of heel pain, though rare, that can present clinically similar toplantar fasciitis. However, this is why podiatric evaluation is often necessary if self directed treatments fail.

Heel Pain in Children:

Plantar fasciitis is rare in growing children. However, growing children that are participating in sports like soccer, basketball, and gymnastics, can develop inflammation of the growth plate on the heel. This is called Sever's disease (also known as calcaneal apophysitis). This is very treatable but needs to be medically evaluated to ensure there is no stress fracture of the heel that is involved.

 

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