Most cases of Heel Pain
are caused when a band of tissue in the foot, known as the plantar fascia, becomes damaged and thickens.
Plantar fasciitis is the medical term for the thickening of the plantar fascia. The plantar fascia is a tough and flexible band of tissue that runs under the sole of the foot. It connects the heel
bone with the bones of the foot, and acts as a kind of shock absorber to the foot. Sudden damage, or damage that occurs over many months or years, can cause tiny tears (microtears) to develop inside
the tissue of the plantar fascia. This can cause the plantar fascia to thicken, resulting in heel pain. The surrounding tissue and the heel bone can also sometimes become inflamed.
Pain in the foot can be due to a problem in any part of the foot. Bones, ligaments, tendons, muscles, fascia, toenail beds, nerves, blood vessels, or skin can be the source of foot pain. The cause of
foot pain can be narrowed down by location and by considering some of the most common causes of foot pain. Plantar fasciitis is the most common cause of heel pain. The plantar fascia, a band of tough
tissue connecting the heel bone to the toes, becomes irritated or inflamed. Heel pain, worst in the morning when getting out of bed, is the most common symptom. Arch pain may also be present.
Pain in the heel can be caused by many things. The commonest cause is plantar fascitis. Other causes include, being overweight, constantly being on your feet, especially on a hard surface like
concrete and wearing hard-soled footwear, thinning or weakness of the fat pads of the heel, injury to the bones or padding of the heel, arthritis in the ankle or heel (subtalar) joint, irritation of
the nerves on the inner or outer sides of the heel, fracture of the heel bone (calcaneum).
Your doctor will perform a physical exam and ask questions about your medical history and symptoms, such as have you had this type of heel pain before? When did your pain begin? Do you have pain upon
your first steps in the morning or after your first steps after rest? Is the pain dull and aching or sharp and stabbing? Is it worse after exercise? Is it worse when standing? Did you fall or twist
your ankle recently? Are you a runner? If so, how far and how often do you run? Do you walk or stand for long periods of time? What kind of shoes do you wear? Do you have any other symptoms? Your
doctor may order a foot x-ray. You may need to see a physical therapist to learn exercises to stretch and strengthen your foot. Your doctor may recommend a night splint to help stretch your foot.
Surgery may be recommended in some cases.
Non Surgical Treatment
Treatment for plantar fasciitis should be directed at resting the plantar fascia, providing support for the arch area and limiting pronation. This is often accomplished with the use of supportive
strapping with athletic tape, arch supports and orthotics. Heel lifts may also be helpful. Anti-inflammatories, pills as well as cortisone injections, may be effective as an adjunctive treatment by
speeding up the reduction of inflammation. However, if used alone, anti-inflammatories rarely lead to resolution of the condition. Stretching exercises, physical therapy and night splints may also be
helpful. The majority of cases respond to non-surgical treatment although it may take several weeks to reach a comfortable level. In those cases that do not respond adequately to conservative
measures, surgical release of the plantar fascia may be considered. However, a new non-surgical treatment called Extracorporeal Shockwave Therapy (ESWT) is now available as an option for recalcitrant
plantar fasciitis. ESWT was approved by the FDA recently for the treatment of chronic heel pain. It has been in use for several years on thousands of patients in Europe and has been successfully used
to restore patients with chronic plantar fasciitis to a normal, active lifestyle. ESWT is a non-invasive procedure that uses high intensity sound waves similar to what is routinely used to treat
kidney stones. The treatment is usually performed in the office or in an outpatient surgical center. The procedure is performed under local anesthesia and takes about 25 minutes. The shockwaves are
directed at the plantar fascia and stimulate an inflammatory healing response.
It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your
heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would
also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the
inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an
operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after
A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel
counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after
running. Pace yourself when you participate in athletic activities. Don't underestimate your body's need for rest and good nutrition. If obese, lose weight.