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 able to distinguish between all the possibilities and determine the underlying source of your heel pain. 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.
Plantar fasciitis occurs because of irritation to the thick ligamentous connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue contributes to maintaining the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. Therefore, the stress placed on the this tissue is tremendous.
The major complaint of those with plantar fasciitis is pain and stiffness in the bottom of the heel. This develops gradually over time. It usually affects just one foot, but can affect both feet. Some people describe the pain as dull, while others experience a sharp pain, and some feel a burning or ache on the bottom of the foot extending outward from the heel. The pain is usually worse in the morning when you take your first steps out of bed, or if you’ve been sitting or lying down for a while. Climbing stairs can be very difficult due to the heel stiffness. After prolonged activity, the pain can flare-up due to increased inflammation. Pain is not usually felt during the activity, but rather just after stopping.
Diagnosis of plantar fasciitis is based on a medical history, the nature of symptoms, and the presence of localised tenderness in the heel. X-rays may be recommended to rule out other causes for the symptoms, such as bone fracture and to check for evidence of heel spurs. Blood tests may also be recommended.
Non Surgical Treatment
Plantar fasciitis treatment can be conservative (non-surgical) or invasive (surgical). Among the non-surgical ways to manage plantar fasciitis involves stretching and icing exercises. A night splint which help stretch the Achilles tendon and plantar fascia overnight, so that they can be more easily stretched during the morning. Orthotics that can be custom-made for the feet can also distribute tension on the feet more consistently. Corticosteroid is injected into the affected area to relieve pain and decrease inflammation. Doctors may also use extracorporeal shockwave therapy before considering plantar fasciitis surgery. During the therapy, sound waves are used to stimulate the affected area and eventually heal it. Physical therapy incorporation, deep massage stretching, and other modalities can at times be a helpful adjunct treatment. Surgery for plantar fasciitis is only considered when all other conservative treatments have failed.
Surgery is rarely used in the treatment of plantar fasciitis. However it may be recommended when conservative treatment has been tried for several months but does not bring adequate relief of symptoms. Surgery usually involves the partial release of the plantar fascia from the heel bone. In approximately 75% of cases symptoms are fully resolved within six months. In a small percentage of cases, symptoms may take up to 12 months to fully resolve.