Four out of every ten patients who present to a foot specialists' office have a complaint of a painful heel. The most common cause of heel pain is Plantar Fascitis or Heel Spur Syndrome. This is an inflammatory condition caused by the stretching or partial tearing of the plantar fascia. The plantar fascia is a thick band of tissue (ligament) connecting the heel bone (calcaneus) to the toes which helps to stabilize the arch of the foot and assists in keeping the toes on the ground. Increases in stress to the foot caused by walking, climbing, running or prolonged standing can result in injury to this structure.
Symptoms occur most commonly at the inside part of the heel and are often most severe when first stepping down in the morning or after long periods of rest. It may feel like a "stone bruise" with intense localized discomfort. The pain may resolve as one "warms up", only to return as activity is continued. It is rare to see any swelling or redness in the inflamed region as the swelling is deep within the foot.
Plantar Fascitis is an overuse injury caused by an excessive amount of activity over a certain period of time. The increased strain of the foot results in pulling on the attachment of the plantar fascia to the calcaneus resulting in small tears (micro-tears) in the fascia. When a person sleeps or rests for an extended time the foot and fascia relax and are re-stretched when stepping down (first step pain). Over time the pulling or traction on the bone can also cause the formation of a heel spur which can be seen on x-ray. The spur doesn't cause the pain but is a result of the injury. X-rays are taken to rule out other arthritic or pathologic factors.
Treatment of Plantar Fascitis consists of decreasing inflammation and supporting the arch of the foot. Initial treatment consists of:
1. Supportive/Stable Shoes
2. Supporting the arch with pads or strappings
3. Stretching exercises for the back of the leg (Achilles tendon) to decrease stress on the foot.
4. Anti-inflammatory medicines taken by mouth.
5. Ice massage twice daily and after activities.
It takes time to develop Plantar Fascitis therefore obtaining compete relief may take four - twelve weeks. In resistant cases the following may be necessary to cure the problem:
1. Local anesthetic and steroid injection
2. Custom orthotics (Shoe inserts)
3. Physical therapy
4. Night Splints - Hold the plantar fascia stretched while sleeping
5. Immobilization in a walking cast/boot.
For patients who don't respond to conservative therapy and who have had to problem for longer than 6 months, there is now a new treatment available to them. In December of 2000, Dr. Siwicki was one of the first Podiatrists trained in the United States with the use of OssaTron to perform Extracorporeal Shock Wave Therapy for treatment of chronic heel pain (Plantar Fascitis or heel spur). He has been doing this procedure at HealthSouth Crestview Surgery Center since January 2001.
Looking for a cure to heel pain? Call Emerald Coast Podiatry in Fort Walton Beach, FL to set up an appointment.