There are many causes of heel pain ranging from nerve entrapments to trauma, but today we will focus on one of the most common causes of heel pain called plantar fasciitis.
Plantar Fasciitis
Plantar Fasciitis: Both heel pain and heel spurs are frequently associated with plantar fasciitis which is an inflammation of the fascial band (made up of fibrous connective tissue) that runs from its attachment at the bottom of the heel along the bottom of the foot and inserting into the ball of the foot.
Plantar Fascia is the name of the band and plantar fasciitis is the condition. “-itis” is latin for inflammation and the inflammation occurs when this band is strained beyond normal extension. Heel spurs are usually a resultant factor of excessive pull but are not usually symptomatic. The symptoms are usually associated with the pulling of the band at its attachment site.
Causes are usually related to athletic lifestyle that causes tightening without the appropriate stretching to compensate, lack of shoe support, lack of arch support, foot structure, weight gain.
These causes consequently lead to inflammation, fascial tearing and excessive strain, pain (worst first step after period of rest or after excessive ambulation) and possible bone spur at the level of attachment secondary to excessive pull/strain.
Diagnosing Plantar Fasciitis
Diagnosing plantar fasciitis begins with proper history from the patient regarding the onset of pain, duration and any triggers. The physician will examine the area, palpating the area of greatest discomfort and may perform radiographs to rule out any bony abnormalities.
Pain will be graded using the standard pain scale of 1-10
Pain grades 1-5 usually start with step 1 of the treatment regimen
Pain grades > 6 jump to step two of the treatment regimen
Chronic conditions that fail to respond to step 1 and 2 will then advance to step 3 surgical treatment options.
3 Step Approach to Treatment of Plantar Fasciitis
Image courtesy of Summit Medical Group
1. Initial Conservative Treatment Options
a series of stretching exercises
taping/strapping
ice therapy
anti-inflammatory medications
nightsplints/brace
2. Additional Conservative Treatment Options
everything in step 1
steroid injections (acute phase)
usually kenalog or dexamethasone mixed with a short and long acting anesthetic
amnion injections (chronic phase)
stem cell properties
shoe inserts/ orthotic devices
A functional orthotic device can correct a biomechanical imbalance and aid in controlling excessive pronation and plantar fascia support to avoid excessive strain
physical therapy
3. Surgical Treatment
Plantar Fasciotomy
Arthroscopic release of plantar fascial band to release tension/strain
Heel spur resection
open/arthroscopic shaving down of prominent heel spur
Prevention
Proper warm up and stretching before and after physical activity/running
Be sure to use appropriate shoe gear for specific activities
Well fitting day to day shoe gear with supportive heel counters
Change running shoes every 400 miles
Shoe inserts/ custom foot orthotics based on foot type for support
If overweight - monitor BMI and work on losing the excess weight
Listen to your body during high intensity activity and rest as needed