Heel pain is one of the most common complaints seen in our office. While there are many causes of heel pain, the most common cause of heel pain is plantar fasciitis. To the general public, the outdated (and inaccurate) term “heel spur” is often used for this condition. While there may be a spur present, it is rarely the reason for the pain. We know this because some studies have shown that as many as 60 percent of people with no heel pain have spurs. From this we see that heel spurs cannot always be the cause of heel pain.
The plantar (foot area) fascia (tissue of the body) is a thick band of tissue that originates at the heel bone, runs along the arch and inserts into the ball of the foot. Plantar fasciitis is inflammation of any portion of this tissue. The weakest link in this tissue is where it originates at the heel bone, and this is where most pain develops.
Heel pain related to the plantar fascia can develop slowly following a period of walking on hard surfaces, over using the foot, wearing shoes with poor support or walking without shoes. Patients have even developed plantar fasciitis from having porcelain tile installed in their house. This unforgiving surface is notorious for causing heel pain.
Excessive body weight can make any foot problem more painful, but in the case of plantar faciitis, body weight has very little to do with the cause.
Signs and Symptoms
The classic sign of plantar fasciitis is “first step pain.” The severity of heel pain is usually at its peak when a person takes their first step in the morning or after sitting for long periods of time. Walking causes the pain to subside, but it does not usually completely stop the pain.
As a day progresses the pain may return and grow worse. The pain is usually not unbearable, and patients will often live with heel pain for months if not years before seeking treatment. This is unfortunate because treatment is much more successful if started early. In addition, patients may make alterations in gait and stance to avoid pain. This change of posture can cause a series of secondary problems including hip and back pain.
Successful treatment of plantar fasciitis involves decreasing the inflammation around the heel and relaxing tight plantar fascia tissues which pulls on the heel. Anti-inflammatory treatment plans often include oral NSAIDS, ice, and rest. In more persistent cases, decreasing the inflammation in the heel is best accomplished with a series of cortisone injections given weekly for three weeks. These shots are mixed with a numbing agent and are administered using a small needle. In addition, the skin will be numbed using a cold spray prior to injection.
Depending on the severity of pain, patients can use stretching techniques. Stretching the plantar fasciitis is accomplished with a combination of the following:
1. Home Exercise Program including exercises to effectively stretch the plantar fascia.
2. Night splints to stretch the plantar fascia while you sleep.
3. The Heeler, a device specifically designed to provide ice massage directly to the plantar fascia.
In the case that plantar fasciitis cannot be treated by using conservative care, we are able to provide a minor surgical procedure. This procedure involves releasing a portion of the plantar fascia from the heel bone. This is done by making two small quarter-inch incisions and endoscopically releasing the fascia. Typically patients are walking on their own again within four to five days. This procedure requires that the patient be mildly sedated and will be performed in an outpatient setting.
Recently a new technique has been developed for treating damaged tendons and fascia. This technique is called Ultrasound Guided Percutaneous Tenotomy/Fasciotomy. To learn more about this new procedure you can read our blog.
Contact our office! We are located in the greater New Orleans area and will cater your needs. Our team will provide long lasting and effective treatment. Call us today at (504)454-3004 or fill out our online appointment request form.