Treatment for Heel Pain
Heel pain is most often caused by plantar fasciitis — a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst. Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is best trained to distinguish between all the possibilities and determine the underlying source of your heel pain.
What is Plantar Fasciitis?
Plantar fasciitis is micro-trauma or micro-degeneration of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes acutely, then chronically injured, resulting in heel pain.
Symptoms of Plantar Fasciitis:
- Pain on the bottom of the heel
- Pain that is usually worse upon arising after periods of rest (especially in the morning upon waking and getting out of bed)
- Pain that increases over a period of months
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 also lead to plantar fasciitis. This is particularly evident when a person’s job requires long hours on their feet. Obesity or rapid weight gain also contributes to plantar fasciitis.
To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis.
In addition, diagnostic imaging studies such as x-rays, a bone scan, or magnetic resonance imaging (MRI) may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but they do not cause the pain. The bony spur grows in the direction of the pull of the fascia, which is parallel to the weight-bearing surface. A heel spur is really just a sign to your doctor on the x-ray that you have had chronic pull on the heel bone by the plantar fascia.
The cornerstone of treatment for plantar fasciitis is stretching the Achilles tendon, posterior (i.e., calves and hamstrings) muscle groups of the legs, and the plantar fascia. Other treatment options include foot tapings/strappings, arch supports, heel lifts, and changing shoe type.
ESWT (Extracorporeal Shock Wave Therapy) is another treatment option which includes delivery of low or high energy shock waves into the plantar fascia. This procedure can be performed in the office with local anesthesia.
Currently my office is investigating the use of Deep Infrared (IR) light therapy for heel pain and the results thus far have been very promising.
Long-Term Care for Heel Pain
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. If you are overweight, it is important to reach and maintain an ideal weight. For all patients, wearing supportive shoes and using custom orthotic devices is the mainstay of long-term treatment for plantar fasciitis.