Plantar fasciitis is the most common cause of Heel Pain
, accounting for around four out of five cases. Plantar fasciitis is when
the thick band of tissue that connects the heel bone with the rest of the foot (the plantar fascia) becomes damaged and thickened. Damage to the plantar fascia is thought to occur following, sudden
damage - for example, damaging your heel while jogging, running or dancing; this type of damage usually affects younger people who are physically active, gradual wear and tear of the tissues that
make up the plantar fascia - this usually affects adults who are 40 years of age or over.
Heel pain is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel. The most common causes of heel pain are Plantar
fasciitis (plantar fasciosis) - inflammation of the plantar fascia. The plantar fascia is a strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot. When the
plantar fasciitis is stretched too far its soft tissue fibers become inflamed, usually where it attaches to the heel bone. Sometimes the problem may occur in the middle of the foot. The patient
experiences pain under the foot, especially after long periods of rest. Some patients have calf-muscle cramps if the Achilles tendon tightens too. Heel bursitis, inflammation of the back of the heel,
the bursa (a fibrous sac full of fluid). Can be caused by landing awkwardly or hard on the heels. Can also be caused by pressure from footwear. Pain is typically felt either deep inside the heel or
at the back of the heel. Sometimes the Achilles tendon may swell. As the day progresses the pain usually gets worse. Heel bumps (pump bumps) common in teenagers. The heel bone is not yet fully mature
and rubs excessively, resulting in the formation of too much bone. Often caused by having a flat foot. Among females can be caused by starting to wear high heels before the bone is fully mature
Tarsal tunnel syndrome, a large nerve in the back of the foot becomes pinched, or entrapped (compressed). This is a type of compression neuropathy that can occur either in the ankle or foot. Chronic
inflammation of the heel pad, caused either by the heel pad becoming too thin, or heavy footsteps. Stress fracture, this is a fracture caused by repetitive stress, commonly caused by strenuous
exercise, sports or heavy manual work. Runners are particularly prone to stress fracture in the metatarsal bones of the foot. Can also be caused by osteoporosis. Severs disease (calcaneal
apophysitis) the most common cause of heel pain in child/teenage athletes, caused by overuse and repetitive microtrauma of the growth plates of the calcaneus (heel bone). Children aged from 7-15 are
most commonly affected. Achilles tendonosis (degenerative tendinopathy) also referred to as tendonitis, tendinosis and tendinopathy. A chronic (long-term) condition associated with the progressive
degeneration of the Achilles tendon. Sometimes the Achilles tendon does not function properly because of multiple, minor microscopic tears of the tendon, which cannot heal and repair itself
correctly, the Achilles tendon receives more tension than it can cope with and microscopic tears develop. Eventually, the tendon thickens, weakens and becomes painful.
Symptoms of plantar fasciitis vary, but the classic symptom is pain after rest--when you first get out of bed in the morning, or when you get up after sitting down for a while during the day. The
pain usually diminishes after a few minutes of walking, sometimes even disappearing, but the pain is commonly felt again the longer you're on the foot. Fasciitis can be aggravated by shoes that lack
appropriate support, especially in the arch area, and by the chronic irritation of long-periods of standing, especially on concrete, by being overweight. It doesn't help that fascia doesn't heal
particularly quickly because it has relatively poor circulation (which is why it's white in colour).
A biomechanical exam by your podiatrist will help reveal these abnormalities and in turn resolve the cause of plantar fasciitis. By addressing this cause, the patient can be offered a podiatric
long-term solution to his problem.
Non Surgical Treatment
Curing posterior heel pain requires calming the inflammation, resting the foot and increasing calf flexibility. Ice therapy and anti-inflammatory medications can be used to reduce the inflammation.
Stopping exercises that stress the calf and Achilles is important. This includes walking, running and the use of stair climbers and elliptical machines. Placing a heel lift in each shoe can reduce
some of the excess strain on the back of the heel. Stretching exercises to increase calf flexibility are important in curing this problem and preventing its recurrence. Wearing running shoes also
provides good foot support and helps with this condition. Sometimes a walking boot is used to immobilize the ankle and let the area completely rest. Physical therapy is sometimes ordered to help
reduce the inflammation and pain and to help improve the flexibility of the calf muscles. Occasionally these measures fail to relieve the pain and surgery may be needed. The surgical procedure
involves removing bone spurs and repairing any damage to the tendon.
When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing
to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most
beneficial for your condition.
The following steps will help prevent plantar fasciitis or help keep the condition from getting worse if you already have it. The primary treatment is rest. Cold packs application to the area for 20
minutes several times a day or after activities give some relief. Over-the-counter pain medications can help manage the pain, consult your healthcare professional. Shoes should be well cushioned,
especially in the midsole area, and should have the appropriate arch support. Some will benefit from an orthotic shoe insert, such as a rubber heel pad for cushioning. Orthotics should be used in
both shoes, even if only one foot hurts. Going barefoot or wearing slipper puts stress on your feet. Put on supportive shoes as soon as you get out of bed. Calf stretches and stretches using a towel
(place the towel under the ball of your feet and pull gently the towel toward you and hold a few seconds) several times a day, especially when first getting up in the morning. Stretching the Achilles
tendon at the back of the heel is especially important before sports, but it is helpful for nonathletes as well. Increasing your exercise levels gradually. Staying at a healthy weight. Surgery is
very rarely required.