PLANTAR FASCIITIS (HEEL PAIN)
Pain of the heel is most commonly caused by inflammation of the plantar fascia. As plantar fasciitis is most common diagnosed for heel pain, it is important to have heel pain properly diagnosed to exclude other causes of heel pain. These causes may include a stress fracture, tendonitis, arthritis, nerve irritation or, rarely, a cyst.
The plantar fascia is a thick band of tissue that connects the heel to the toes. It assists in maintaining the foot arch and act as a shock absorber. When the plantar fascia get irritated under tension forces, it develops splits and become inflamed, resulting in heel pain.
Causes
Plantar fasciitis is most commonly caused by existing structural condition of the foot, such as very flat feet or feet with high arch. Overuse and excessive exercise may contribute to plantar fasciitis.
Wearing non-supportive shoes and walking on hard flat surfaces irritates the plantar fascia and can lead to plantar fasciitis. Weight gain and obesity may contribute to development of plantar fasciitis.
Symptoms
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Pain on the bottom of the heel
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Pain in the arch of the foot
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Pain that is usually worse upon first steps upon arising or after prolonged rest.
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Swelling on the bottom of the heel
People with plantar fasciitis often describe the pain as worst upon taking their initial steps out of bed after arousal or after they have been sitting for long periods of time. After minutes of walking, the pain fades because walking stretches the calf muscles. In some cases, the pain subsides but returns after spending long periods of time of standing.
Diagnosis
You doctor will obtain your medical history and examine your foot in order to rules out all other causes for your heel pain other than plantar fasciitis.
Diagnostic imaging studies, such as x-rays or other imaging modalities, may be used to distinguish the different types of heel pain and evaluate the foot arch. Sometimes heel spurs are present with plantar fasciitis, but these are rarely a source of heel pain.
Treatment
First line treatment of plantar fasciitis can begin at home. It consists of:
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Stretching exercises. Stretching exercises of the calf muscles reduce the tension forces exerted on the plantar fascia, therefore, it help ease pain and assist with recovery.
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Proper shoe wear. Wearing supportive shoes that has good arch support and slightly elevated heel reduces tension on the plantar fascia. Avoid walking bare foot.
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Ice. Applying an ice pack to your heel for about 20 minutes several times a day helps reduce inflammation. Do not apply ice directly to the skin.
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Limit activities. Lowering your physical activities to rest your plantar fascia helps providing it a chance to heal.
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Medications. Prescribed or over the counter oral nonsteroidal anti-inflammatory drugs (NSAIDs), may reduce pain and inflammation.
How your doctor may approaches to manage heel pain:
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Padding and strapping. Placing heel pads in the shoe would soften the impact of walking. Strapping the foot would support the arch of the foot and reduce tension forces exerted on the plantar fascia.
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Orthotic devices that support your foot arch can be fit into your shoe to help recreate the foot arch and reduce the tension forces that cause plantar fasciitis.
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Injection therapy. In some cases, corticosteroid and local anesthetic injected to the inflamed tissue to help relieve pain and reduce inflammation.
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Night splint. Wearing a night splint helps maintain the calf muscles stretched over night sleep. This reduces the morning pain experienced.
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Physical therapy. Calf and Achilles stretching exercises and other physical therapy measures may be used to help provide relief.
When Is Surgery Needed?
A small percentage of patients do not respond to conservative management. These patients are considered a candidate for surgery after few months of failure to respond to conservative management. Your doctor will discuss the surgical options and determine the most appropriate approach to your condition.
Long-Term Care
Plantar fasciitis is a recurrent condition as long as the underlying causes that led to this condition remain. Therefore, you will need to continue wearing supportive shoes, Achilles stretching exercising and using orthotic devices for long-term treatment of plantar fasciitis.