There are many causes of heel pain. These can include
nerve irritation and/ or entrapment
However by and large, the most common cause of heel pain is plantar fasciitis.
Many people also call this heel spur syndrome. Heel spurs are present when there is a small bony calcification at the bottom of the heel. Typically it is the inflamed plantar fascia that causes the pain, not the spur itself.
It is important to have the cause of your heel pain accurately assessed. A foot specialist is able to distinguish between all the possibilities and determine the underlying source of your heel pain, and therefore construct the most effective treatment plan for you.
What Is Plantar Fasciitis?
The plantar fascia is a fibrous band of tissue that runs along the bottom of the foot, from the heel to the ball of the foot. It is a non-elastic tissue that typically will not stretch. Over-extending this tissue, as in cases of "flat feet", or excess stress on the fascia (such as from standing on hard surfaces for long periods of time), can result in irritation and tears. When the plantar fascia becomes irritated, this results in pain and inflammation. Typically the most common area of pain is at the weakest link, where the fascia inserts into the heel, but pain may occur anywhere along the length of the tissue.
The most common cause of plantar fasciitis relates to faulty structure 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.
Certain activities that put increased weight and forces through the feet, such as running and jumping can also be a pre-cursor to plantar fasciitis. Wearing non-supportive footwear on hard, flat surfaces can also put abnormal strain on the plantar fascia. This is particularly evident when one’s job requires standing for long hours at a time. Obesity may also contribute to plantar fasciitis.
How does it feel?
The most common symptoms of plantar fasciitis are:
Pain on the bottom of the heel
Pain in the arch of the foot
Pain that is usually worse in the morning or after rest
Pain that increases over a period of months
People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. Pain can vary for each person, from sharp stabbing heels to a bruised feeling. Usually after a few minutes of getting up and moving, the pain usually gets better or may go away completely. This is because walking helps to remove the inflammation and swelling that settles in while at rest.
In more advanced cases, the pain may not go away at all.
First line treatment of plantar fasciitis begins with conservative options.
Stretching exercises - Stretch out the calf muscles at the back of the calf help ease pain and promote better foot function. Tight muscles can cause the foot to over-compensate and put extra stress on soft tissues.
Wear shoes! - When you walk without shoes, you put extra stress on your plantar fascia. This means wearing good supportive shoes at home as well.
Wear good shoes! - Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
Ice - Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. An even better option is rolling your foot on a frozen water bottle. This not only helps with the pain and inflammation, but also helps to strengthen the small muscles of the foot that prevent your arch from collapsing.
Padding - A gel heel insert/ cushion in your shoe will give extra cushion and help to take the sting out of your steps
Limit activities - Cut down on extended physical activities to give your heel a rest.
Medications - anti-inflammatory drugs such as ibuprofen or naproxen may be recommended to reduce pain and inflammation.
If you still have pain after several weeks, or if it went away but came back, you may likely need more intensive assessment and treatment. A foot specialist can determine which or all of the following therapies should be added to your treatment plan.
Orthotics - Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis. Often even with the best medication, exercises and physical therapies, if you do not address the root cause of the problem, the pain will keep coming back.
Medication - When over the counter medications do not provide sufficient relief, prescription strength medications may be added to your treatment plan.
Physical therapy - Treatments such as laser, ultrasound and shockwave therapy are often successful in alleviating stubborn symptoms.
Corticosteroids - In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
Removable walking/ air cast - A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal in severe cases.
Night splint - Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
Is Surgery Needed?
In the large majority of cases, surgery is not considered. Most people with plantar fasciitis respond well to non-surgical conservative treatments. However a very small percentage of patients may benefit from surgery.
No matter what your treatment for plantar fasciitis involves, the underlying causes that led to this condition may remain. People often forget the pain and the treatment once they feel better. But if the causes are not addressed, the pain and symptoms are almost guaranteed to recur.
It is so important to continue with preventive measures. Supportive and stable shoes, proper stretching and strengthening exercises, as well as wearing custom orthotic devices to control foot function are the cornerstones of long-term treatment and prevention of plantar fasciitis.
Guelph: (519) 823-1450
Milton: (289) 242-3668
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