Heel pain is the most common complaint podiatrist see in our offices. The pain is greatest usually when you get up in the morning, but continues to worsen over time, until it hurts with every step you take and can even ache at night when resting.
This syndrome is most commonly caused by several factors, including, but not limited to:
- Tight calf muscles
- Increase in body weight
- Sudden change in the amount of intensity of exercise
- Improper or worn out shoes
- Abnormal foot biomechanics (excessive pronation or supination)
Due to any of the above factors, the plantar fascia (the ligament that holds up your arch) is pulled or strained so that a portion of this very strong ligament starts to tear or fray like a rope at its weakest point (where it attaches to you heel bone). This tearing causes microscopic internal bleeding in this area. Your body reacts by causing inflammation, which in turn causes irritation to the nerves, bursae and muscles in this area. As the inflammation occurs, the body tries to heal itself by depositing calcium in the area of the tear. This creates the spur. Not everyone will have a visible spur on x-ray, especially in the early stages. The spur is not the cause of the pain! It is just a tangible sign that extensive tearing has occurred. The tearing and straining is the cause of the pain and then the nerve becomes inflamed which makes the pain more sharp and long-lasting. The straining must be stopped, along with the inflammation, in order to resolve this problem.
Diagnosis of plantar fasciitis is made with a physical examination including a biomechanical exam. X-ray are recommended to rule out a stress fracture or tumor in the area. Shoe gear is also evaluated.
Treatment initially includes all of the items listed below. If any of these treatments increases your pain, please call or contact the office. It has been estimated that 85% of heel pain can be eliminated by non-surgical treatments; but these take time and effort on the part of the patient and doctor. Your heel pain did not appear overnight, and it will take a while to totally eliminate the pain.
Conservative therapy can include:
- Ice (for at least 15 minutes, twice a day);
- Stretching (your doctor will give you calf and arch stretching)
- Anti-inflammatories (either orally or in an injection)
- Arch supports/Taping/or orthotics.
Remember that treating the biomechanics of your feet treats the underlying cause where the other treatments are only treating the symptoms! Some people need physical therapy, night splints, and casting for relief. Conservative treatment often takes 4-6 months to eliminate plantar fasciitis.
EPAT (Extracorporeal Pulse Activation Treatment) therapy is an effective conservative treatment that is often necessary if you have had heel pain for more than 4-6 months. It is a non-invasive, in-office procedure that uses unique pressure waves that stimulate the metabolism, enhance blood circulation and accelerate the healing process. The damaged tissue gradually regenerates over a 12 week period and eventally heals.
Surgical treatment is the last alternative, after conservative therapy has been exhausted. Extracorporal shock wave therapy (ESWT) is a relatively non-invasive surgery that is quite effective, but deemed experimental by many insurance companies. If you are interested in more information about ESWT, my website has an article posted on the subject.
There are two surgical approaches to heel pain: the traditional approach (removes the spur) and the endoscopic approach (lengthens the ligament to reduce the strain and therefore reduce your pain). If your pain is not eliminated by conservative treatment after 4-6 months, we will discuss which approach is best for you.
Remember, the earlier you seek medical help for heel pain, the faster it will go away! If you have pain more than 5-7 days in a row in the same spot, contact your podiatrist for an appointment.