Heel pain is one of the most common conditions to affect the foot. It is usually felt as an intense pain when the affected heel is used. The pain is usually worse when you get out of bed in the
morning or after a long period of activity. In most cases, only one heel is affected. After walking, the pain usually improves. However, it is common for it to be painful when you first take a step
after a period of rest. The pain often worsens by the end of the day. Most cases of Heel Pain
are caused by damage and thickening of the plantar fascia. Sometimes, the
surrounding tissue and the heel bone also become inflamed (swollen).
Heel pain is often the result of the plantar fascia being overstretched or overused. Risk factors include. Obesity or sudden weight gain. Long distance running. Tight Achilles tendons. Shoes with
poor arch support or soft soles. Foot arch problems (both high arches and flat feet).
Plantar fascia usually causes pain and stiffness on the bottom of your heel although some people have heel spurs and suffer no symptoms at all. Occasionally, heel pain is also associated with other
medical disorders such as arthritis (inflammation of the joint), bursitis (inflammation of the tissues around the joint). Those who have symptoms may experience ?First step? pain (stone bruise
sensation) after getting out of bed or sitting for a period of time. Pain after driving. Pain on the bottom of your heel. Deep aching pain. Pain can be worse when barefoot.
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
If pain and other symptoms of inflammation-redness, swelling, heat-persist, you should limit normal daily activities and contact our office, or another doctor of podiatric medicine. Your foot would
be examined, and an X-ray may be taken to rule out problems of the bone. Early treatment might involve oral or injectable anti-inflammatory medication, taping, padding, massage, stretching, exercise,
shoe recommendations, physiotherapy, over-the-counter shoe inserts or, if the condition is chronic and there is a biomechanical basis to the complaint, orthoses (or orthotic devices) may be used to
permanently take strain off the fascia. Only rarely is surgery required for heel pain. If necessary, however, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa,
or removal of a neuroma or other soft-tissue growth.
Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on
several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a
small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under
the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal
tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia
attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released
from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.
A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel
counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after
running. Pace yourself when you participate in athletic activities. Don?t underestimate your body's need for rest and good nutrition. If obese, lose weight.