Heel pain is most frequently caused by plantar fasciitis, a condition that is occasionally also called heel spur syndrome when a spur is present. Heel pain may also exist because of other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst. Because there tend to be several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is able to distinguish between all the possibilities and determine the underlying source of your heel pain.
What Is Plantar Fasciitis?
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this situation, the fascia first becomes irritated and then inflamed, resulting in heel and arch pain.
The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have difficulties 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 especially noticeable when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:
• Stretching exercises that stretch out the calf muscles help ease pain and assist with recovery.
• Avoid going barefoot when you walk without shoes, you put undue strain and stress on your plantar fascia.
• 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 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 and a slightly raised heel reduces stress on the plantar fascia.
• Oral nonsteroidal anti-inflammatory medications (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:
• Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
• Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
• In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
• A removable walking cast may be used to keep your foot immobile for a few weeks to enable it to relax and recover.
• Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help decrease the morning pain experienced by a number of patients.
• Exercises and other physical therapy steps may be used to help provide relief.
When Is Surgery Needed?
Although most patients with plantar fasciitis respond to non- surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial. 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 custom orthotic devices are the mainstays of long-term treatment for plantar fasciitis.