The most common cause of heel pain is plantar fasciitis. Plantar fasciitis is grossly defined as a thickening of the ligament (the plantar fascia) that connects the heel bone to the toes. The plantar fascia aids in holding up the arch and with shock absorption for standing and walking. It is also part of a pulley system to aid in toe push off when walking and running. The ligament can have tiny tears from overuse, which causes heel pain with first steps in the morning or after a period of rest. Pain can dissipate after walking, however pain tends to return with prolonged standing and walking. Plantar fasciitis is often associated with a heel spur on the bottom of the heel bone, but a spur does not have to be present to be symptomatic.
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Symptoms
Plantar fasciitis presents with symptoms of stabbing/sharp pain in the bottom of the foot at the heel. Mild swelling can be felt in the arch of the foot if persistent ligament thickening is present. Pain is often temporarily relieved with icing the area. Barefoot walking tends to exacerbate the pain, especially on hard surfaces, such as concrete, wood floors or on tile. Pain can radiate to the toes or towards the calf along the back of the heel in more complicated cases but this is very rare. Radiating pain should be investigated for a condition involving the nerves. People often describe the pain as a “stone bruise” feeling to the sole of the heel bone. Limited dorsiflexion or “upward motion” at the ankle is often present in people with plantar fasciitis.
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Causes
Tension and stress on the fascia can cause small tearing and inflammation leading to pain and swelling in the heel and fascia. Factors that increase the risk of developing plantar fasciitis include age (between 40 and 60 years old); activities, such as long-distance running, ballet dancing, and aerobics; flat feet; atypical gait cycle; obesity; new or inappropriate shoes and finally occupations which require long hours of walking or standing on hard surfaces. A tight gastroc complex (calf muscle) can lead to an overpull of the plantar fascia and lead to pain and inflammation.
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Treatment
Most patients recover with conservative treatment such as arch supports (orthotics), rest, icing, stretching and modifying activities. Supporting the plantar fascia (arch) is one of the most important things you can do to reduce additional ligament tearing and allow for healing. Other valuable treatment options include physical therapy or splinting, such as a night splint to stretch the calf muscle and help reduce overpronation. A localized cortisone injection from a Chiropodist can be immediately effective to reduce pain and swelling. Non-steroidal anti-inflammatory medications, such as ibuprofen may be necessary as well. Ultrasound therapy and Extracorporeal Shock Wave treatments have also been utilized with excellent success, prior to considering surgical options. Severe pain or delayed treatment may require a period of non-weight bearing in a boot to decrease the inflammation present.
