Heel Pain/Plantar Fasciitis
The heel is the largest bone in the foot and responsible for bearing the weight of the entire body. Many people develop heel pain at some point in their lives, whether on the underside or back of the heel. In most cases, heel pain is not a symptom of a serious underlying health condition. However, it can affect a person’s quality of life, including the ability to stand, walk or exercise without discomfort.
Dr. Barksdale will evaluate your heel pain to determine the underlying condition and tailor a treatment plan to help you get relief and back on your feet.
Heel pain can be caused by many different conditions, some more common than others. Often, patients who visit a podiatrist for heel pain are suffering from Achilles tendonitis or plantar fasciitis. However, other conditions can also cause heel pain, including bone fractures, excessive pronation, gout, bursitis, fibromyalgia, arthritis and peripheral neuropathy.
You should see a podiatrist for heel pain that persists for several weeks despite efforts to rest, ice and to elevate your feet at home. You should also contact your doctor about heel pain that continues when you are not standing or pain that is severe and occurs with swelling.
One of the most common causes of heel pain is plantar fasciitis, which is the result of inflammation of the thick tissue that crosses the bottom of the heel. This tissue or tendon, known as the plantar fascia, connects the heel to the toes. Being subject to the weight of the whole body as well as any impact or jarring individuals impose upon it, it is one of the most frequently injured parts of the foot. Not to mention, various individuals are predisposed to this type of heel pain because of their body composition and lifestyle. Understanding the causes as well as some of the ways these issues can be offset can help individuals avoid this type of heel pain and enjoy a healthier, more active lifestyle.
The main symptom of plantar fasciitis is pain beneath the heel on the bottom of the foot. Pain may occur in one or both feet.
- The pain may be sharp and severe
- It is usually worse in the morning or after sitting for long periods
- Pain tends to improve with activity but will worsen again after long periods on your feet
- Pain is worse after (not during) exercise or activity
A doctor will take a medical history and perform a physical exam of the feet. No specific lab tests or imaging studies are needed to diagnose plantar fasciitis but they may be used to rule out other causes of heel pain such as fractures, tumors, or arthritis.
Imaging tests may include:
- Magnetic resonance imaging (MRI) scan
- Bone scan
- Computerized tomography (CT) scan
- Electromyography (EMG)
Blood tests may include:
- Complete blood count (CBC)
- Erythrocyte sedimentation rate (ESR)
- Complete metabolic panel
- Rheumatoid factor studies
More than 90% of patients with plantar fasciitis will improve within 10 months using conservative treatment methods that include:
- Stopping or limiting activities where there is repetitive heel impact or that worsen pain
- Ice the area for 20 minutes up to four times daily, to help relieve pain
- Try rolling your foot over a frozen water bottle
- Stretching exercises
- Tight muscles in the feet and calves can aggravate plantar fasciitis
- Over-the-counter (OTC) pain medications
- Nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil, Motrin) or naproxen (Aleve)
- Wear protective footwear for temporary pain relief
- Athletic shoes
- Arch-supporting shoes
- Shoes with rigid shanks
- Cushion-soled shoes with gel pad inserts or heel cups
- Orthotics to properly support the foot may help
- Tape the foot with a technique called “low-Dye taping”
- Splints worn overnight may be helpful to provide pain relief and a gentle stretch
- Avoid wearing slippers or going barefoot
If conservative measures do not relieve the pain caused by plantar fasciitis, other treatments include:
- Physical therapy for long-term pain relief
- Contrast baths
- Steroid injections in the foot to relieve pain
- The effect may wear off in a few weeks
- Botulinum toxin type A injection
- May help with pain relief and overall foot function
- Walking cast
- Surgery is rarely needed for plantar fasciitis and is only recommended when all other treatments have failed symptoms persist for at least 6 to 12 months
- Fasciotomy surgery involves detaching the plantar fascia from the heel bone
- Cryosurgery destroys damaged tissue
- Bipolar radiofrequency microdebridement applies a bipolar radiofrequency pulse to the plantar fascia
- Autologous blood injection, platelet-rich plasma (PRP) injection, nitroglycerin patches, and extracorporeal shock-wave therapy (ESWT) are treatments designed to create an acute inflammatory reaction and restart the healing process
- Extracorporeal shock wave therapy (ESWT) has not yet been shown to be effective, but it is approved by the Food and Drug Administration (FDA) to treat plantar fasciitis and may be recommended by some clinicians