Heel Pain
articles and medical information from Dr. Nichols

Definition

There are many reasons for heel pain. One of the most common causes is a condition called Plantar fasciitis. Plantar fasciitis is a condition in which patients experience heel pain where the plantar fascia attaches to the calcaneus (heel bone). The plantar fascia is a tight thin fibrous sheath that runs along the bottom of the foot. Plantar fasciitis involves inflammation of both the plantar fascia and the bone to which it attaches. Often this is due to degeneration of the fibers of the plantar fascia that originate from the heel bone.

Women experience plantar fasciitis twice as often as men and some patients may experience pain in both heels.

Clinical Symptoms

Patients experience pain on the bottom of the heel bone. It is often very severe when the patient first wakes up or rises up from a resting position. This occurs because the plantar fascia is being stretched. Patients may experience less heel pain with nonweightbearing activity and increased heel pain when going barefoot.

Treatment

Most patients will find relief from their symptoms with conservative treatment. Surgery is not advisable unless at least 6 months of conservative therapy has been attempted.

Initial treatment involves using a silicon rubber or lift heel pad and starting a home program for stretching of the Achilles tendon and plantar fascia. After 8 weeks of initial treatment 95% of patients experience marked improvement of their symptoms.

Other aids used to decrease inflammation of the painful heel include taking anti-inflammatory medication and use of contrast baths, ice, and/or shock-absorbing shoes.

Patients who experience symptoms after 8 weeks may be offered a cortisone injection and a formal physical therapy consultation. If symptoms persist further, the next step is wearing a nonremovable cast, night splint, or custom orthotic device.

In Dr. Nichols practice many patients have experienced significant relief with a referral to a board certified pedorthist. The pedorthist tapes their foot to provide "Plantar Fasciitis Heel Spur" suspension which takes pressure off the area of heel pain. In many cases this single treatment has relieved the plantar fasciitis and no further intervention has been needed.

This information is excerpted from Essentials of Musculoskeletal Care by R. K. Snyder.