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.
The cause of plantar fasciitis is often unclear and may be multifactorial. Because of the high incidence in runners, it is best postulated to be caused by repetitive microtrauma. Possible risk factors include obesity, occupations requiring prolonged standing and weight-bearing, and heel spurs. Other risk factors may be broadly classified as either extrinsic (training errors and equipment) or intrinsic (functional, structural, or degenerative). Training errors are among the major causes of plantar fasciitis. Athletes usually have a history of an increase in distance, intensity, or duration of activity. The addition of speed workouts, plyometrics, and hill workouts are particularly high-risk behaviors for the development of plantar fasciitis. Running indoors on poorly cushioned surfaces is also a risk factor. Appropriate equipment is important. Athletes and others who spend prolonged time on their feet should wear an appropriate shoe type for their foot type and activity. Athletic shoes rapidly lose cushioning properties. Athletes who use shoe-sole repair materials are especially at risk if they do not change shoes often. Athletes who train in lightweight and minimally cushioned shoes (instead of heavier training flats) are also at higher risk of developing plantar fasciitis.
The symptoms of plantar fasciitis include pain in the bottom of your foot, especially at the front or centre of the heel bone, pain that is worse when first rising in the morning (called "first-step pain"), when first standing up after any long period of sitting, or after increased levels of activity especially in non-supportive shoes. Seek medical advice about plantar fasciitis if you have heel pain or pain in the bottom of your foot, especially when you get up in the morning, that does not respond to treatment or if there is redness or bruising in the heel.
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 or other imaging modalities 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.
Non Surgical Treatment
Plantar fasciitis is usually controlled with conservative treatment. Following control of the pain and inflammation an orthotic (a custom made shoe insert) will be used to stabilize your foot and prevent a recurrence. Over 98% of the time heel spurs and plantar fasciitis can be controlled by this treatment and surgery can be avoided. The orthotic prevents excess pronation and prevents lengthening of the plantar fascia and continued tearing of the fascia. Usually a slight heel lift and a firm shank in the shoe will also help to reduce the severity of this problem. The office visit will be used for careful examination and review to distinguish plantar fasciitis and plantar heel pain syndrome from other problems, many of which are outlined below. It is important to distinguish between a stress reaction of the calcaneus and plantar fasciitis. A feature of many calcaneal stress fractures is pain on lateral and medial compression of the calcaneus.
Like every surgical procedure, plantar fasciitis surgery carries some risks. Because of these risks your doctor will probably advise you to continue with the conventional treatments at least 6 months before giving you approval for surgery. Some health experts recommend home treatment as long as 12 months. If you can’t work because of your heel pain, can’t perform your everyday activities or your athletic career is in danger, you may consider a plantar fasciitis surgery earlier. But keep in mind that there is no guarantee that the pain will go away completely after surgery. Surgery is effective in many cases, however, 20 to 25 percent of patients continue to experience heel pain after having a plantar fasciitis surgery.
Stretching exercises for your foot are important. Do the stretches shown here at least twice a day. Don't bounce when you stretch. Plantar fascia stretch. To do the plantar fascia stretch, stand straight with your hands against a wall and your injured leg slightly behind your other leg. Keeping your heels flat on the floor, slowly bend both knees. You should feel the stretch in the lower part of your leg. Hold the stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times. Calf stretch. Stand with your hands against a wall and your injured leg behind your other leg. With your injured leg straight, your heel flat on the floor and your foot pointed straight ahead, lean slowly forward, bending the other leg. You should feel the stretch in the middle of your calf. Hold the stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times. Other exercises. You can also strengthen your leg muscles by standing on the ball of your foot at the edge of a step and raising up as high as possible on your toes. Relax between toe raises and let your heel fall a little lower than the edge of the step. It's also helpful to strengthen the foot by grabbing a towel with your toes as if you are going to pick up the towel with your foot. Repeat this exercise several times a day.