Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. 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 foot and ankle surgeon is
able to distinguish between all the possibilities and determine the underlying source of your heel pain. Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends
from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.
The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body's natural response to injury is
inflammation, which results in the heel pain and stiffness of plantar fasciitis.
Plantar fasciosis is characterized by pain at the bottom of the heel with weight bearing, particularly when first arising in the morning; pain usually abates within 5 to 10 min, only to return later
in the day. It is often worse when pushing off of the heel (the propulsive phase of gait) and after periods of rest. Acute, severe heel pain, especially with mild local puffiness, may indicate an
acute fascial tear. Some patients describe burning or sticking pain along the plantar medial border of the foot when walking.
Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your plantar fasciitis they will investigate
WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts. X-rays may show calcification within the plantar fascia or at its
insertion into the calcaneus, which is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests
(including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.
Non Surgical Treatment
A number of conservative measures can help take stress off the plantar fascia and encourage healing, including Icing, Taping the arch and bottom of the foot, Stretching, especially the calf, Avoiding
walking with bare feet, especially on hard surfaces, Wearing orthotics or arch supports, Taking over-the-counter anti-inflammatories. If these methods fail, we generally try one of two things, A
cortisone injection can help reduce swelling. Often a single injection will do the trick, but occasionally a second injection may be needed. Alternatively, we can try extracorporeal pulse activation
therapy, or EPAT. This method uses sound waves to penetrate to the plantar fascia and stimulate the bodyâs healing response. We typically do one treatment a week for three weeks, with complete
healing taking between nine to 12 weeks.
The majority of patients, about 90%, will respond to appropriate non-operative treatment measures over a period of 3-6 months. Surgery is a treatment option for patients with persistent symptoms, but
is NOT recommended unless a patient has failed a minimum of 6-9 months of appropriate non-operative treatment. There are a number of reasons why surgery is not immediately entertained including.
Non-operative treatment when performed appropriately has a high rate of success. Recovery from any foot surgery often takes longer than patients expect. Complications following this type of surgery
can and DO occur! The surgery often does not fully address the underlying reason why the condition occurred therefore the surgery may not be completely effective. Prior to surgical intervention, it
is important that the treating physician ensure that the correct diagnosis has been made. This seems self-evident, but there are other potential causes of heel pain. Surgical intervention may include
extracorporeal shock wave therapy or endoscopic or open partial plantar fasciectomy.