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HEEL PAIN
One of the most common complaints in the podiatrist's office is that of heel pain. In excess of ninety percent of heel pain complaints are diagnosed as having inflammation of the plantar fascia, or a ligament on the bottom of the foot. Commonly referred to as a heel spur or stone bruise, plantar fasciitis (plantar fashitis) can be a severely debilitating and painful condition. Frequently described as a deep burning ache, the pain is most commonly experienced early in the morning when first placing the feet on the ground, and also following a short period of rest, for example, when getting up to walk after watching television for an hour or two.
What causes the pain is any one or combination of things. A change in shoe gear, an increase in physical activity, an increase in weight, or simply a naturally flexible foot type all contribute to the development of plantar fasciitis.
The plantar fascia is a fibrous, broad band of tissue that attaches from the heel bone, calcaneus, and fans out to attach to the heads of the metatarsal, (balls of the toes). The function of the plantar fascia is to provide stability and prevent the arch from flattening.
Primarily due to a flexible foot type and thousands of foot steps per day, the plantar fascia pulls on the heel bone, causing small micro-tears from the bone, resulting in severe inflammation and pain. When sitting or sleeping the body attempts to heal the area, resulting in slight contracture of the fascia. Unfortunately, the eight hours of sleep is not sufficient to heal the inflammation, and the patient walks causing persistent flattening out of the arch and ultimate pulling on the heel bone. This revolving circle of inflammation and pain continues until successful treatment is achieved.
Treatment is directed at minimizing the flexibility and flattening of the arch. Until it is realized that the etiology is a mechanical one, final resolution of pain may never be attained. Simply prescribing anti-inflammatory medication without addressing the mechanical etiology may temporarily relieve the pain, but seldom permanently alleviates the cause.
Patients frequently attribute the development of a heel spur as the cause of their pain. It is true that a heel spur or development of a bony spur may have resulted from the chronic inflammation; however, the patient is not walking directly on the spur. The heel spur is not the cause of the pain, but is the result of the inflammation.
Treatment is directed at minimizing the flexibility and flattening of the arch. Until it is realized that the etiology is a mechanical one, final resolution of pain may never be attained. Simply prescribing anti-inflammatory medication without addressing the mechanical etiology may temporarily relieve the pain, but seldom results in permanent resolution of pain. Treatment must be direct at decreasing the flexibility of the foot by way of an arch support or shoe insert. Along with a short course of anti-inflammatory medication (Advil, Motrin, Aleve, Naprosyn) or other NSAID, a custom made insert, orthotic, is frequently the treatment of choice for plantar fasciitis.
On average 96% of heel pain patients achieve relief after surgery. For those who are unable to attain relief with several weeks of conservative treatment regimen (taping, padding, anti-inflammatory medication, steroid injections, stretching exercises, PT, etc) surgery may be a viable option.
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Please call the office with any concerns regarding insurance coverage.
Some insurance plans require a referral prior to being seen by a specialist (podiatrist).
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