Heel pain is most commonly referred to as plantar fasciitis and in the past as heel spur syndrome. Heel pain may also be due to other causes such as a stress fracture, tendinitis, arthritis, nerve irritation or a bone tumor.
Because there are several potential causes of heel pain, it is important to have a proper diagnosis. After your reviewing your history and performing a detailed examination, Dr. Blackmer will be able to determine the underlying source of your heel pain.
What Is Plantar Fasciitis?
Plantar fasciitis is an inflammation of the band of tissue (plantar fascia) that extends from the forefoot to the heel bone (calcaneous). In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain. Sometimes the nerve at the inside of the heel near the skin can be scarred down and inflamed.
The most common cause of plantar fasciitis relates to a faulty structure of the foot. For example, people who have problems with their arches (either overly flat feet or high-arched feet) and a tight Achilles tendon are more prone to developing plantar fasciitis.
Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia, which may also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Also, obesity may also contribute to plantar fasciitis. There are typically two types of heel spurs on the bottom of the heel bone. One is when the spur is pointed horizontal towards the toes which rarely causes pain and is the result of fascia attempting to lengthen itself by pulling the outer sheath of the bone resulting in bleeding and a deposit of bone within the fascia. The second may be caused by an arthritic condition where the spur is pointed vertical towards the weight bearing surface and in this case causing pain. These can be easily differentiated with an x-ray and/or ultrasound.
- Pain on the bottom of the heel
- Pain that is usually worse upon standing first thing in the morning or when standing after sitting for a period of time
- Pain after being on the foot all day
- Pain that increases over a period of months
- Compensation pain in the ball of the foot and/or the outside of the midfoot
People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain may decrease, because walking stretches the fascia. For some people the pain subsides but then returns after spending more time on their feet throughout the day.
To arrive at a diagnosis, Dr. Blackmer will obtain detailed medical history and examine your foot. Throughout this process he will rule out the possible causes for your heel pain other than plantar fasciitis.
In addition, diagnostic imaging studies such as x-rays, diagnostic ultrasound, MRI or bone scan may be used to distinguish the different causes of your heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain.
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:
- Stretching exercises. Stretching and thus lengthening the calf muscles help ease pain and assist with recovery and reoccurance. This is the most important non-surgical treatment for this condition. After the pain subsides, this should be continued indefinitely to avoid reoccurrence.
- 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 minutes several times a day helps reduce inflammation. Place a thin towel between 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, rigid heel counter 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 ankle surgeon, 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 or preformed orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
- Corticosteroid Injections: Corticosteroid injections are used to help reduce the inflammation and relieve pain. Typically you cannot receive more than 3 injections in a 12-month period. The doctor will do everything possible to make your injection comfortable.
- Pneumatic boot: 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 to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients and also lengthen the calf muscle.
- Physical therapy: Exercises and other physical therapy measures may be used to help provide relief.
When Is Surgery Needed?
Although over 95% of our patients with plantar fasciitis respond to non-surgical treatment, a very small percentage of patients may require surgery. After we have exhausted all conservative treatment options and you still continue to have heel pain, surgery will be considered. The surgery that Dr. Blackmer usually performs is an Endoscopic Plantar Fasciotomy. This involves 2 very small incisions where a small portion of the fascia is incised under the visualization of a micro-camera similar to arthroscopy.
No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using orthotic devices.