Heel pain is one of the most frequently treated ailments in our office. Although heel pain can be caused by many different disorders, such as arthritis, collagen diseases, overuse, trauma, etc. The overwhelming majority of heel pain is caused by plantar fasciitis. This painful heel is usually called “heel spur syndrome”.
Plantar fasciitis/heel spur syndrome is an inflammation of a thick band of tissue at the bottom of the foot called the plantar fascia. The inflammation of the plantar fascia, at its origin at the heel bone (calcaneus), causes the classic symptoms of pain at the bottom and/or side of the heel. This is most painful upon arising in the morning or when standing after rest, and the stretching inflames the painful area even more. The pain can exist with or without a “heel spur”. The pain is caused by the stretching and inflammation of the plantar fascia, and not by the bone spur. The spur is the result of the pulling of the fascia at the heel bone, resulting in the proliferation of the bone, often referred to as “heel spur”.
Many patients are seen with severe, acute heel pain, and they do not have any heel spur on X-ray. In addition, often heel spurs of all sizes are seen on X-rays of patients that do not have any heel pain. As a general rule, THE PRESENCE OF A HEEL SPUR IS NO INDICATION OF THE AMOUNT OF PAIN THAT EXISTS. THE PAIN IS USUALLY NOT FROM THE HEEL SPUR BUT IS FROM THE STRETCHING AND INFLAMMATION OF THE PLANTAR FASCIA. Therefore, treatment is directed at decreasing the bulk of the plantar fascia and supporting the fascia during weight bearing to decrease inflammation.
Most of the common treatment options are as follows:
Anti-inflammatory medication is taken by mouth. These medications treat symptoms of pain and inflammation but do not treat the cause of the pain. Patients with ulcers or who are allergic to Aspirin-like medications cannot take these medications.
Heel cushions with or without cut-out areas or Heel Cups. It has been our experience that heel cushions are of very little value unless a bruise caused the heel pain. Plantar fasciitis cannot be supported in the arch with the use of heel cushions.
Physical therapy using whirlpool, ultrasound, electrical stimulation, Iontophoresis, or stretching is often very effective and treats the symptoms (pain and inflammation) as well as the cause (stretching the tightness of the plantar fascia and Achilles tendon).
Taping/strapping of the foot often provides dramatic relief for the patients, because the taping addresses the cause of the problem by supporting the plantar fascia.
Orthoses, often known as orthotics or custom-made arch supports, are inserts for your shoes that mechanically correct the foot, as well as support the plantar fascia, therefore reducing the discomfort. Orthoses are available in many varieties from over-the-counter to custom-made. Although orthotics are expensive, they usually last 10-15 years before your foot prescription changes.
Injections of a mixture of local anesthetic and Cortisone are used to locally and directly reduce pain and inflammation. Although results are usually very good with injections, once again, the cause of the problem is not being addressed. It is generally accepted that no more than 3 injections should be given during a year.
Soft tissue wraps such as fabrifoam Pronation Spring Control, support the plantar fascia and are often a simple and cost-effective way to decrease symptoms.
Casting, placing the foot and lower leg in a cast for several weeks, allows the tissue to slowly stretch and the inflammation to subside. The majority of cases respond to other methods of treatment, and casting is seldom necessary.
Plantar fascia splints are also used to treat plantar fasciitis and heel spur syndrome. There are plantar fascia splints that are made to fit the back of the leg and bottom of the foot which is known as a plantar splint or a splint that is worn on top of the foot, ankle, and leg known as a dorsal splint.
Another conservative treatment that is effective in treating plantar fasciitis that is chronic in nature is shockwave therapy. Chronic plantar fasciitis is referred to plantar fasciosis which is a chronic thickening of the plantar fascia. Plantar fasciosis can then be challenging to treat and resolve. Besides the conservative measures mentioned, shockwave therapy also known as Extracorporeal Shock Wave therapy can be performed. It uses shockwave to stimulate healing to the thickened plantar fascia.
Surgery is utilized when conservative measures have not been successful or when the patient and the Doctor have decided that surgery is in their best interest. Newer techniques have drastically changed the way surgery is performed and usually decrease the post-operative discomfort and recovery period. A method called Endoscopic Plantar Fasciotomy involves surgically releasing a portion of the tight plantar fascia using an endoscope through two ½ inch incisions. The scope allows for accurate placement with monitoring of the procedure and visualization of the tissues on a television screen. This reduces trauma and post-operative discomfort. This high-tech procedure and small incision usually allow for a quicker recovery. However, it must be stressed, that over 95% of patients in our office DO NOT REQUIRE SURGERY, and have symptoms relieved with conservative care.
For evaluation, confirming diagnosis, and treatment options, make an appointment with Dr. Novabilski