Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress
fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst. Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is
able to distinguish between all the possibilities and determine the underlying source of your heel pain. Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends
from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.
Each time we take a step forward, all of our body weight first rests on the heel of one foot. As our weight moves forward, the entire foot begins to bear the body's weight, and the foot flattens and
this places a great deal of pressure and strain on the plantar fascia. There is very little elasticity to the plantar fascia, so as it stretches only slightly; it pulls on its attachment to the heel.
If the foot is properly aligned this pull causes no problems. However, if the foot is "pronated" (the foot rolls outward at the ankle, causing a break down of the inner side of the shoe), the arch
falls excessively, and this causes an abnormal stretching of the relatively inflexible plantar fascia, which in turn pulls abnormally hard on the heel. The same pathology occurs with "supination"
(the rolling inward of the foot, causing a break down of the outer side of the shoe). Supinated feet are relatively in flexible; usually have a high arch, and a short or tight plantar fascia. Thus as
weight is transferred from the heel to the remainder of the foot, the tight plantar fascia hardly stretches at all, and pulls with great force on its attachment to the heel.
The most common symptoms of plantar fasciitis include pain on the bottom of the foot near the heel, pain with the first few steps after getting out of bed in the morning, or after a long period of
rest, such as after a long car ride. The pain subsides after a few minutes of walking. Greater pain after (not during) exercise or activity.
Plantar fasciosis is confirmed if firm thumb pressure applied to the calcaneus when the foot is dorsiflexed elicits pain. Fascial pain along the plantar medial border of the fascia may also be
present. If findings are equivocal, demonstration of a heel spur on x-ray may support the diagnosis; however, absence does not rule out the diagnosis, and visible spurs are not generally the cause of
symptoms. Also, infrequently, calcaneal spurs appear ill defined on x-ray, exhibiting fluffy new bone formation, suggesting spondyloarthropathy (eg, ankylosing spondylitis, reactive arthritis. If an
acute fascial tear is suspected, MRI is done.
Non Surgical Treatment
Most people who have plantar fasciitis recover with conservative treatments in just a few months. Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve) may ease the pain
and inflammation associated with plantar fasciitis. Stretching and strengthening exercises or use of specialized devices may provide symptom relief. These include physical therapy. A physical
therapist can instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist may also
teach you to apply athletic taping to support the bottom of your foot. Night splints. Your physical therapist or doctor may recommend wearing a splint that stretches your calf and the arch of your
foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching. Orthotics. Your doctor may prescribe off-the-shelf heel cups,
cushions or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.
When more conservative methods have failed to reduce plantar fasciitis pain, your doctor may suggest extracorporeal shock wave therapy, which is used to treat chronic plantar fasciitis.
Extracorporeal shock wave therapy uses sound waves to stimulate healing, but may cause bruises, numbness, tingling, swelling, and pain. When all else fails, surgery may be recommended to detach the
plantar fascia from the heel bone. Few people need surgery to treat the condition.
Stretching exercises for your foot are important. Do the stretches shown here at least twice a day. Don't bounce when you stretch. Plantar fascia stretch. To do the plantar fascia stretch, stand
straight with your hands against a wall and your injured leg slightly behind your other leg. Keeping your heels flat on the floor, slowly bend both knees. You should feel the stretch in the lower
part of your leg. Hold the stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times. Calf stretch. Stand with your hands against a wall and your injured leg behind your other leg. With your
injured leg straight, your heel flat on the floor and your foot pointed straight ahead, lean slowly forward, bending the other leg. You should feel the stretch in the middle of your calf. Hold the
stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times. Other exercises. You can also strengthen your leg muscles by standing on the ball of your foot at the edge of a step and raising up as
high as possible on your toes. Relax between toe raises and let your heel fall a little lower than the edge of the step. It's also helpful to strengthen the foot by grabbing a towel with your toes as
if you are going to pick up the towel with your foot. Repeat this exercise several times a day.