Without a doubt, our feet work hard bearing the brunt of keeping us on our toes and moving around. And when we experience foot issues, the pain can impact everything from mood to mobility. Heel pain is one of the most common foot ailments we see, with causes ranging from fractures and bone tumors to cuts and bruises. But more often than not, heel pain may result from a condition called plantar fasciitis.
The plantar fascia is a long, wide, thick fibrous band of tissue that runs from the ball of the foot down the bottom of the foot and inserts into the bottom and sides of the heel bone (or calcaneus). Under normal circumstances the plantar fascia adds integrity to the arch, but occasionally one will develop inflammation where their plantar fascia inserts into the bottom or sides of the heel bone, and this inflammation is called plantar fasciitis. If this area remains stressed, the body can react by laying down new bone at the area of irritation which might develop into a “heel spur.” The bone spur, if present, doesn’t cause the pain – the chronic inflammation does.
Common complaints with plantar fasciitis are “the pain feels worse with the first steps in the morning” or “after I sit awhile and get up to walk, my heel and foot are very painful.” Pain associated with this condition is often worse at the end of the day.
Common causes of plantar fasciitis:
- changes in the structural integrity of the arch with age
- a tight heel cord or tight Achilles tendon
- rapid increase in body weight
- trauma and stress related to foot type
- age-related loss of a plantar fat cushion under the heel
Treatment starts with proper diagnosis and in most cases this can be made with a good medical history, clinical examination and imaging studies such as an X-ray or ultrasound. Once the diagnosis has been made, attention is directed towards reducing the immediate inflammation. Once under control, the underlying cause can be addressed to prevent future episodes of discomfort.
Treatments range from conservative to surgical. Conservative treatment works most of the time and may include cortisone injections, arch supports or orthotics, physical therapy such as ultrasound and electrical stimulation, stretching exercises, night splints and medication. Once diagnosed, it’s important to stretch your feet and calves before exercise.
Surgical treatment is reserved for patients who don’t respond to conservative therapy and usually involves an endoscopic surgical procedure (a small camera is inserted into the heel and a portion of the plantar fascia is released). Surgically treated patients are fully weight bearing on day one, and usually back in an athletic shoe in five days, although it may take several months to fully recover.
By Dr. John Marino, DPM, Roper St. Francis Physician Partners Orthopaedics