Heel Pain / Plantar Fasciitis

Heel Pain / Plantar Fasciitis
The most common cause of deep pain on the bottom surface of the heel is Plantar Fasciitis (inflammation of the plantar fascia). The plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot, from the heel to the toes. It is just below the skin and subcutaneous fat.It helps to secure the arch of the foot. Long standing inflammation causes the deposition of calcium at the point where the plantar facia inserts into the heel bone. This can result in the appearance of a bony heel spur on x-ray. The spur itself is not the source of the pain. Stubborn heel pain should be evaluated by a Podiatrist. Plantar fasciitis may also present as pain anywhere along the sole of the foot, particularly along the arch and just in front of the heel.
Symptoms
• Sharp pain often localized to the bottom and/or inside margin of the heel
• Pain often worse on arising in the morning and after rest
• Aggravated by prolonged weight bearing and ambulation
• May severely limit activities
• Most common in middle-aged and overweight adults
Cause
• Excessive flattening of the arch on weight bearing
• Tight plantar fascia
• Over-pronation of the foot (a complex motion including outward rotation of the heel and inward rotation of the ankle).
• Excessive load on the foot from increased body weight
Diagnosis
The diagnosis of plantar fasciitis is confirmed by very specific examination of the back of the heel related to the location of the pain under the heel. There is often a nerve that is simultaneously inflamed or pinched underneath the fascia. This can aggravate the pain even further.
Treatment
The treatment of plantar fasciitis is straightforward. It is designed to cushion the heel, stretch out the fascia and support the arch of the foot. The main treatment involves cushioning the heel with a silicone heel pad. Stretching exercises for the back of the heel are done on a regular basis, two to three times daily. Stretching out the foot at night using a specially designed night splint or brace maintains the foot in a straight up position. This prevents it from dropping down during the night. The natural position of the foot during sleep rests the fascia, which then is subjected to vigorous stress again when getting up and walking in the morning. Keeping the fascia stretched at all times (but particularly at night) seems to help. If these methods of treatment fail, a cortisone injection into the back of the heel will often reduce the inflammation. More than one cortisone injection is not a good idea because it weakens the heel pad and can even aggravate the condition. If none of these treatments are sufficient, the next alternatives are shockwave therapy or surgery. Shockwave therapy is a unique treatment where a high frequency, ultrasound impulse is transmitted to the back of the heel to break up the scarring. You may have heard of similar treatments to treat kidney stones. Alternatively, surgery may be performed through a small incision on the back of the heel to release the plantar fascia and, in some cases, release the nerve that is pinched at the same time. The treatments are highly effective in relieving the chronic pain if cushioning, stretching and immobilization fail.
What you can do
• Application of ice to the heel area after prolonged activity
• Stretching exercises
• Night splint
• Heel cushions & Arch supports
• Wear supportive shoes with a stiff heal counter
• Sometimes a shoe with a moderately high heel will relieve pressure on the fascia
What we may do
• Teach specific stretching and strengthening exercises to stretch plantar fascia and strengthen the small intrinsic muscles which stabilize the arch
• Control faulty foot function with orthotics
• Inject powerful anti-inflammatory medication to calm inflammation around the painful area
• Apply tape/ padding to relieve strain on the plantar fascia
• Administer physical therapy (ie ultrasound,)
• Prescribe special splints to help stretch the fascia
• In some cases surgical release of the plantar fascia and excision of the heel spur (rarely required).