Heel Pain

HEEL PAIN (PLANTAR FASCIOSIS/FASCIITIS)

What is heel pain?

Heel pain can be caused by a variety of factors, but it is most commonly caused by plantar fasciitis. Other causes may include stress fracture, arthritis, or tendonitis. As you may notice, since there are several causes, it is important to schedule a doctor appointment when heel pain is present to have a proper diagnosis. Dr Amir is trained specially to distinguish between all of the possible causes to determine the underlying source of the patient’s heel pain. 

What is plantar fasciitis?

Plantar fasciitis exists when the band of tissue extending from the heel to the toes, the plantar fascia, becomes increasingly deteriorated. When the area becomes irritated, inflammation occurs and then leads to heel pain. Sometimes, this condition is called heel spur syndrome when a spur is present.

Plantar fasciitis develops most commonly due to the improper natural structure of the patient’s foot. Patients are prone to developing this condition due to flatfoot or higher-than-average arches. Additionally, when improper shoes are worn on hard surfaces, the patient will not have enough support when the foot meets the ground, resulting in strain and pain. Workers who stand on their feet for long hours of the day can easily develop plantar fasciitis due to the consistent strain. Obesity can also contribute to the condition, since an increasing amount of weight is placed on the foot structures, creating pain.

What are the symptoms? 

• Pain located on the bottom of the heel
• Pain that is experienced the strongest upon arising
• Pain that increases over some time

Patients with plantar fasciitis experience worse pain upon arising or after sitting for long periods because the fascia is tightened when not in use. Typically, patients’ pain levels decrease once they’ve stretched the fascia by walking around for a little while. For many patients, the pain does temporarily subside, but then resumes after spending long periods spent standing.

How is a diagnosis made? 

To arrive at a diagnosis, Dr Amir will obtain the patient’s medical history and examine the feet. During the examination, Dr Amir rules out all the possible causes for the heel pain until plantar fasciitis is the only accurate explanation. Dr Amir may also order X-rays to help distinguish and determine the source of the heel pain. When the imaging studies are conducted, Dr Amir may identify heel spurs, but the spurs are rarely the source of the pain. When the spurs are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

What are the treatment options?

It is important to try non-surgical treatment options initially, which a local podiatrist will be able to tailor to the patient’s particular case. Treatment options include:

• Padding and strapping – placing pads in the shoe to alleviate pain while walking, and straps to support the foot, reducing strain on the fascia
• Custom orthotic devices – to help correct the underlying structural abnormalities causing the plantar fasciitis
• Injection therapy – to help reduce inflammation and pain
• Removable walking cast – to create immobility, allowing the foot to rest and heal 
• Night splint – maintain extended stretch, reducing the pain experienced upon arising
• Physical therapy – to help alleviate pain

When is surgery needed?

Although most patients with plantar fasciitis respond well to non-surgical treatment, a small percentage of patients may require surgery. Surgery is only considered after several consistent months of non-surgical treatment. Dr Amir will discuss the surgical options with the patient and determine which approach is most beneficial.