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.
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.
The most common cause of plantar fasciitis relates to the faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.
Wearing nonsupportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity and overuse may also contribute to plantar fasciitis.
The symptoms of plantar fasciitis are:
Pain on the bottom of the heel
Pain in the arch of the foot
Pain that is usually worse upon arising
Pain that increases over a period of months
Swelling on the bottom of the heel
People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they have been sitting for long periods of time. After a few minutes of walking, the pain decreases because walking stretches the fascia. For some people, the pain subsides but returns after spending long periods of time on their feet.
To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process, the surgeon rules out all possible causes for your heel pain other than plantar fasciitis.
In addition, diagnostic imaging studies, such as x-rays or other imaging modalities, may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home, such as icing, stretching exercises, limiting activities, shoe modifications, and medications. If you still have pain after several weeks, Dr. Levine may add treatment processes such as orthotic devices, injection therapy, or physical therapy.
Although most patients with plantar fasciitis respond to nonsurgical treatment, a small percentage of patients may require surgery. If, after several months of nonsurgical treatment, you continue to have heel pain, surgery will be considered. Dr. Levine will discuss the surgical options with you and determine which approach would be most beneficial for you.
No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
If you are experiencing heel pain or symptoms of plantar fasciitis, it's important that you get it checked out as soon as possible. Click here to book an appointment to have it assessed.