Heel pain is most often caused by plantar fasciitis — a condition that is sometimes also called heel spur syndrome. 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. A podiatrist is best trained to distinguish between all the possibilities and determine the underlying source of your heel pain.
Plantar fasciitis is an inflammation of the long ligament (the plantar fascia) that extends from the heel to the toes. When the fascia is excessively stretched, it first becomes irritated and then inflamed resulting in heel pain.
The symptoms of plantar fasciitis are:
- Pain on the bottom of the heel
- Pain that is usually worse upon arising. 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.
- Pain that increases over a period of months
The most common cause of plantar fasciitis relates to 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 non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly common in people who’s job requires long hours on their feet. Obesity also contributes to plantar fasciitis.
Diagnostic imaging studies such as x-rays, a bone scan, or magnetic resonance imaging (MRI) 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:
- Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
- Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
- Ice. Putting an ice pack on your heel for 10 minutes several times a day helps reduce inflammation. Cut down on extended physical activities to give your heel a rest.
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, Advil, Motrin may help reduce pain and inflammation.
- Lose weight. Extra pounds put extra stress on your plantar fascia.
If you still have pain, see your podiatrist, who may add one or more of these approaches:
- Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis. They work in 90% of cases if the cause is biomechanical in origin.
- Padding and strapping. Placing pads in the shoe reduces the impact of the ground on the foot. Strapping helps support the foot and reduce strain on the fascia if it is very painful.
- Injections. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain in cases that are difficult.
- Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
- Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
- Shockwave therapy
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery may be considered. Your podiatrist 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. If you are overweight, it is important to reach and maintain an ideal weight. For all patients even when the pain is gone, using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis to prevent the symptoms from recurring.