Heel pain is one of the most common conditions that I see in my office. It affects many people from different walks of life. Some patients come to see me after they've had heel pain for several years. Others, after only a short period of time. What makes them come to a doctor for heel pain is usually some incident that has increased their pain or cause them to not be able to have the quality of life they want to pursue. Heel pain can be miserable. Heel pain can stop patients from exercising, going for a walk with grandchildren, playing with their families, or enjoying a day at the Park. Family outings can become a torture.
Who gets heel pain?
Heel pain can affect almost anybody. Heel pain is seen in athletic populations, children, and adults. There are several causes of heel pain that are commonly seen. Some are related to nerve conditions, some are related to growth plates, but by far the most frequently seen is plantar fascia related. The people who get pain in the plantar fascia that I see in my practice frequently have risk factors such as an elevated body mass index (being overweight), working on a hard surface, recent increase in activity, insufficient support in the shoes or inadequate shoes. Another group that gets plantar heel pain are people that are very active. Especially if they pursue high-impact activities. Overall, the percent of people that get heel pain according to most studies is around 10%.
Most people who get heel pain from plantar fasciitis have pain on the bottom of the heel and usually is towards the inside of the heel. The pain is usually worse in the morning or after a period of rest. It is generally aggravated by activity and goes away when the patient sits down and gets pressure off the foot. The pain can be very sharp and cause the patient to limp or avoid putting weight on the heel or just a low grade nuisance. Most people complain that their first few steps in the morning are very difficult and after a few minutes the heel starts to feel better.
A lot of factors can play a role in making the plantar fascia painful. The plantar fascia is a ligament that runs from your heel to your toes. If you take your toes and bring them up, most of you will see a band stick out in the middle of your arch. That is actually part of the plantar fascia. The reason the plantar fascia hurts in the heel more frequently than other locations is because it is where the impact occurs when you walk, and because the plantar fascia takes a lot of stress in that area in normal gait. Eventually, this causes inflammation and degeneration within the ligament. This inflammation and degeneration results in significant pain.
Heel spurs are bone-growth that looks like a spur at the insertion of the plantar fascia on the heel. They're seen more frequently in patients with painful heels but they are also seen quite frequently in patients that have no pain. The presence or absence of a heel spur does not make the diagnosis of plantar fasciitis but does suggest the presence of the disease. The spur does not (usually) need to be removed to alleviate heel pain. Many many people live their whole lives with heel spurs with no pain in their heels.
Ice twice a day for 20 min, stretching by pulling the toes up several times a day for 2 min., and wearing good shoes with good arch supports, can all be very helpful in heel pain treatment. Also high quality running shoes can be very helpful to provide cushion for the heels. One word of caution, a good arch support should cause no more than 30 or $40. There are many retail stores now selling “custom orthotics” for exorbitant amounts of money that are nothing more than over-the-counter arch supports. A custom orthotic, if made properly takes a few days for the manufacture of this device. If someone goes into the back room, and brings out a device on the same day of your visit, that is an over-the-counter device and should not cost more than 30 or $40. We dispense many pairs of over-the-counter devices every week in our office. We also make custom orthotics that sell for substantially more money but patients are individually examined, evaluated, and casted for these devices. There is about a two-week delay for the patient to receive the orthotics. There is also a break in period of time with these devices with specific instructions on how to use them.
Probably the most important thing that a podiatrist can provide you with is the correct diagnosis. In our office we use diagnostic ultrasound, and x-rays to evaluate the patient and make the correct diagnosis. In about 10% of the patients come into our office, the plantar fascia is not involved in the patient's pain. As mentioned above, specific instructions in stretching and strengthening of the foot can be given. Also your doctor can provide you with appropriate suggestions on shoe gear and arch supports or custom orthotics. Additionally, injections can be given. There are other devices that we use in the treatment of heel pain as well such as night splints, and occasionally cam walkers.
If the patient has gone through a consistent, thorough conservative treatment regimen for heel pain that has been diagnosed as plantar fasciitis, other treatments are available. Extracorporeal shockwave therapy (which is basically using an impact device on the plantar fascia to ignite an inflammatory response to promote healing) is one option. There are various surgery options available to release the plantar fascia and decrease stress on the insertion. These have the drawback of causing some loss of support to the arch. There is also thermal destruction of nerve treatments which are available. These are relatively noninvasive (like having a big injection). Radiowave treatment is also an alternative for chronic, recalcitrant heel pain. Only about 1 out of every 10-15 patients with heel pain ends up having surgery of any kind. The majority of patients can be canceled conservatively.
Most patients with heel pain can be treated successfully without too much fuss. Doing a few things can dramatically affect your quality of life. Contact us for more information or to schedule an appointment!
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