Heel Pain

Heel pain is one of the most common complaints seen in the podiatrist's office. While there are many causes of heel pain, the problem is more often than not something called 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 To the general public, the outdated (and inaccurate) term "heel spur" is often used for this condition.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. Studies have shown that as many as 60 percent of people with no heel pain have spurs.

The plantar fascia is a thick band of tissue that originates on the heel bone and runs along the arch to insert 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. The onset of pain is usually gradual and may develop following a period of over-activity, walking on hard surfaces, wearing unsupportive shoes, or walking barefoot. Patients have even developed plantar fasciitis from little more than having porcelain tile installed in the home. This unforgiving surface is notorious for causing heel pain.

Although excessive body weight can make any foot complaint more painful, it is not a major factor in the onset or perpetuation of this condition. Weight loss is only a small aspect to the treatment of plantar fasciitis. Also worth mentioning is that overweight patients who opt for surgical treatment have a much higher success rate than patients that are not overweight.
The classic sign of plantar fasciitis is "first step pain". Pain is worse when the person stands up first thing in the morning or after sitting for a while. Walking causes the pain to subside, but it does not usually disappear completely. As the day progresses the pain may return and grow worse. The pain is usually not unbearable, and patients will often live with their pain for months if not years before seeking treatment. This is unfortunate as treatment is much more successful if started early. In addition, patients may make alterations in gait and stance to avoid pain, resulting in a series of secondary problems.

Successful treatment of plantar fasciitis involves decreasing the inflammation around the heel and relaxing tight plantar fascial tissues pulling on the heel. Anti-inflammatory modalities often include oral NSAIDS, cortisone injections, ice, and rest. Alleviation of the traction from the plantar fascia can be accomplished by stretching exercises, taping, orthotics, and massage. A new device called the "HEELER" is specially designed to combine both of these modalities.

While not often required, there is a surgical option for cases of stubborn plantar fasciitis.  The procedure involves releasing a portion of the plantar fascia form the heel bone. The procedure is performed endoscopically and patients are usually walking in their own shoes again within four to five days.

The most recent advance in the treatment of plantar fasciitis is orthotripsy. Orthotripsy involves a high impact sound wave similar to lithotripsy used to break up kidney stones. The procedure requires no skin incisions and is performed in an outpatient setting under mild sedation. While the procedure shows great promise, there are often problems with insurance coverage because it is a new technology.