Heel pain is unlike most body aches and injuries because heels can?t be immobilized to rest and recover, at least without considerable inconvenience to the sufferer. Heels can?t be isolated and splinted either ,as body weight will continue to aggravate the condition with every step. Heel pain can be devastating if left untreated, eventually impairing the ability to walk comfortably-or at all. Most heel pain comes from tendon problems, though some types can come from bone issues as well.
A sharp stabbing pain, like a nail going into the bottom of the heel when first stepping on the foot after getting out of bed or after sitting for period of time, is the most common description for plantar fasciitis or heel spur syndrome. Typically the pain eases off as the day goes on but it may not go away completely. A thick ligament that attaches to the bottom of the heel and runs the length of the foot to the toes can become inflamed and swollen at the attachment site. This tends to be an overuse type of injury where poor foot structure is involved; also, wearing of shoe gear that lacks adequate support (ie: worn out shoes, boots and flip-flops) and prolonged standing or walking are often implicated. A throbbing pain that gets worse as the day goes on and can be worse at night when laying in bed is most often associated with an irritated or entrapped nerve on the inside of the ankle or heel. This is similar to carpel tunnel syndrome in the wrist and hand. Approximately 7 / 10 patients with heel pain have a component of nerve entrapment as the cause of their heel pain. This is also one of the most common causes of chronic heel pain because it is often missed as a diagnosis. When nerve entrapment is considered to be a cause, painless neurosensory testing is performed with the Pressure Specified Sensory Device? (PSSD) at The Foot & Ankle Center, PC to determine the extent of compression. A less common cause of heel pain but a stress fracture is often considered in athletes, such as long distance runners, who have heel pain. Posterior Heel Pain (Retrocalcaneal) This is pain in the back of the heel that flares up when first starting an activity. It is often associated with a large bump that can be irritated by shoes. The Achilles tendon attaches to the back of the heel and, like on the bottom, this attachment site can often become inflamed; a spur may or may not be present. Another painful area is a sac of fluid (bursa) that sits between the tendon and bone to act as a cushion for the tendon. This bursa can become inflamed often leading to significant pain called retrocalcaneal bursitis.
Symptoms of plantar fasciitis vary, but the classic symptom is pain after rest--when you first get out of bed in the morning, or when you get up after sitting down for a while during the day. The pain usually diminishes after a few minutes of walking, sometimes even disappearing, but the pain is commonly felt again the longer you're on the foot. Fasciitis can be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation of long-periods of standing, especially on concrete, by being overweight. It doesn't help that fascia doesn't heal particularly quickly because it has relatively poor circulation (which is why it's white in colour).
A podiatrist (doctor who specializes in the evaluation and treatment of foot diseases) will carry out a physical examination, and ask pertinent questions about the pain. The doctor will also ask the patient how much walking and standing the patient does, what type of footwear is worn, and details of the his/her medical history. Often this is enough to make a diagnosis. Sometimes further diagnostic tests are needed, such as blood tests and imaging scans.
Non Surgical Treatment
Most patients get better with the help of nonsurgical treatments. Stretches for the calf muscles on the back of the lower leg take tension off the plantar fascia. A night splint can be worn while you sleep. The night splint keeps your foot from bending downward. It places a mild stretch on the calf muscles and the plantar fascia. Some people seem to get better faster when using a night splint. They report having less heel pain when placing the sore foot on the ground in the morning. There have been a few studies that reported no significant benefit from adding night splinting to a program of antiinflammatory meds and stretching. Other studies report the benefits of short-term casting to unload the heel, immobilize the plantar fascia, and reduce repetitive microtrauma. Supporting the arch with a well fitted arch support, or orthotic, may also help reduce pressure on the plantar fascia. Placing a special type of insert into the shoe, called a heel cup, can reduce the pressure on the sore area. Wearing a silicone heel pad adds cushion to a heel that has lost some of the fat pad through degeneration. Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It's possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells causes an increase in blood flow to the area. Recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function.
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. No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
It may not be possible to prevent all cases of heel pain. However, there are some easy steps that you can take to avoid injury to the heel and prevent pain. Whenever possible, you should wear shoes that fit properly and support the foot, wear the right shoes for physical activity, stretch your muscles before exercising, pace yourself during physical activity, maintain a healthy diet, rest when you feel tired or when your muscles ache, maintain a healthy weight.