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Heel pain is most often caused by an inflammtion due to chronic damage of th Plantar Fascia (a band of connective tissue - ligament) inserting into the heel bone (calcaneus). Some people may have a spur evident on x-rays, yet others may not. The problem is due to inflammation caused by the Plantar Fascia actually tearing away from the heel bone, not from a bone spur. It is an over-use syndrome. Poor biomechanics of the feet may be a large contributor. A tight Achilles heel cord (gastroc-equinus) is usually part of the problem as well.
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 condition, the fascia first becomes irritated and then inflamed-resulting in heel pain.
Symptoms of Plantar Fasciitis
The symptoms of plantar fasciitis are:
Causes of Plantar Fasciitis
The most common cause of plantar fasciitis relates to faulty biomechanics 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 also contributes to plantar fasciitis.
Diagnosis
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 these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
Treatment Options
Our approach to the treatment of plantar fasciitis is a comprehensive approach, emphasising things you can do at home:
Rest: Decreasing the Stress on the Plantar Fascia through decreased activities.
Ice: using a frozen bottle on the bottom of the heel for 10-15 minutes, several times daily is a fantastic - natural anti-inflammatory.
Anti-Inflammatory Medications (NSAIDs), such as Ibuprofen: Dr. Tillett is not a big fan of anti-inflammatory medicines, but over-the-counter anti-inflammtories can be helpful after activities when the pain is at its worst. However, caution should be taken in order to not take the medicines in order to reduce pain in order to be more active - expecially to participate in sports, and make sure you have no allergies that would be problematic with the Anti-Inflammatories.
Protecting our feet from the strain of daily activity - Change the environment your feet are functioning in:
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Avoid going barefoot. Walking
without the support of shoes, maximizes the stress accross the Plantar Fascia.
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Some attention to proper shoes is important...shoes, you put undue strain and stress on your plantar fascia. Rigid, non-flexible shoes with a moderately raised heel biomechanically offers further reduction of the strain of the Plantar Fascia.
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Orthotic devices. Custom Biomechanically Corrective orthotic devices that are custom made to restore your foots natural function, can be designed to fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis
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Night splint. These have recently become a 1st line therapy. Recent studies show that patient's who wear a night splint reduce the heeling time to less than half. They help maintain an the position of the foot, while sleeping or just off of your feet, closer to where it would when standing. This will reduce the damage caused when you get up to walk again, due to the healing of the Plantar Fascia in a tightened position when not wearing the boot.
Stretching exercises: By stretching out specific calf muscles we directly reduce the strain placed on the Plantar Fascia, and help ease pain and speed recovery.
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Additonal Therapies to be considered in recalcitrant or extreme cases: Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
Physical therapy: Exercises and other physical therapy measures may be used to help provide relief.
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 for you.
