Heel Pain

Plantar fasciitis is the term commonly used to refer to heel and arch pain traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia, that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Overpronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation.

Also known as heel spur syndrome, the condition is often successfully treated with conservative measures, such as the use of anti-inflammatory medications, ice packs, stretching exercises, orthotic devices, and physical therapy. Note: Please consult your physician before taking any medications. In persistent cases, Extracorporeal Shock Wave Treatment (ESWT) may be used to treat the heel pain.

Pain in the heel is one of the most common complaints that a foot specialist hears. the cause of heel pain is one of the most controversial subjects in the specialty. With treatment, however, most patients can be relieved of their symptoms.

The Cause: The most common cause of heel pain is the pull on the heel exerted by the muscles and ligaments that support the arch of the foot, an overuse condition similar to bursitis of the shoulder or tennis elbow. Other causes of heel pain include: nerve entrapment, stress fracture of the heel bone, inflammatory diseases or a bruise of the fat pad under the heel.

The Condition: The pain typically is worse in the morning and with walking, but tends to get better through the day. Individuals with flat feet and tight heel cords are frequently affected, as are those who are overweight or overdo in athletics. A heel spur is seen on X-ray in only about half of the cases of heel pain. It forms at the attachment of muscles and ligaments to the heel. Heel spurs are not the cause of the pain, however, many heel spurs are not painful at all.

The Treatment: Heel pain, even without treatment, will usually subside, but may take a long time. the treatment is done in stages, according to the duration of the problem and the degree of the pain.

Stage 1: Anti-flammatory medications, temporary shoe inserts, temporarily limited activities and heel cord stretching will usually relieve the condition when it begins.

Stage 2: If the problem continues, the tender area can be injected with hydrocortisone and a local anesthetic. It also helps at this stage to tape the arch, and continue with a stronger anti-inflammatory medication.

Stage 3: If the problem persisits, a custom molded orthotic is used, and continued use of anti-inflammatory medication.

Stage 4: For the difficult, chronic problem, a cast can be tried. Either a removable type such as a slipper cast, a cast brace, or a standard walking cast. A night splint can also help.

Stage 5: Surgery can be done if other treatments fail. The aim is to release tight ligaments, relieve nerve pressure, or do both. Removal of the spur can also be done at this same time.

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