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Heel Pain -- Plantar Fasciitis and Heel Spurs

Heel pain is commonly associated with plantar fasciitis and heel spurs. Plantar fasciitis happens when the band of tissue supporting the arch of the foot becomes irritated and inflamed. This condition is sometimes also called heel spur syndrome (or, heel spurs) when a bone spur is present.

What Is Plantar Fasciitis?
 
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. More than two million patients are treated for this condition every year. In this condition, the fascia first becomes irritated and then inflamed—resulting in heel pain.
 
Symptoms of Plantar Fasciitis Include:
  • Pain on the bottom of the heel
  • Pain that is usually worse when getting up in the morning
  • Pain that increases over a period of months
People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people, the pain subsides but returns after spending long periods of time on their feet. 
 
Heel pain, plantar fasciitis and heel spursCauses of Plantar Fasciitis
 
The most common cause of plantar fasciitis relates foot structure. For example, people with either overly flat feet or high arches are more prone to developing plantar fasciitis.
 
Overpronation is also a cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation.
 
Risk factors include wearing non-supportive footwear on flat, hard surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when a person’s job requires long hours on their feet. Obesity also contributes to plantar fasciitis.
 
What is a Heel Spur?
 
Heel spurs and plantar fasciitis are sometimes related. A heel spur is a calcium deposit causing a bony protrusion on the underside of the heel bone. Also known as heel spur syndrome, the condition is often successfully treated with conservative measures, such as the use of anti-inflammatory medications, ice packs, stretching exercises, orthotic devices, and physical therapy. Note: Please consult your physician before taking any medications. In persistent cases, Extracorporeal Shock Wave Treatment (ESWT) may be used to treat the heel pain
 
Other Causes of Heel Pain
 
Heel and foot pain may also be due to other causes, like 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 podiatric foot and ankle surgeon is best trained to distinguish between all the possibilities and determine the underlying source of your heel pain.
 
Diagnosis
 
To arrive at a diagnosis, the podiatric foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis.

In addition, diagnostic imaging studies such as x-rays, a bone scan, or magnetic resonance imaging (MRI) may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
 

Plantar Fasciitis Treatment Options 

  • Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:
  • Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery. 
  • Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia. 
  • Ice. Putting an ice pack on your heel for 10 minutes several times a day helps reduce inflammation. 
  • Limit activities. Cut down on extended physical activities to give your heel a rest. 
  • Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia. Your shoes should provide a comfortable environment for the foot. 
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce pain and inflammation. 
  • Lose weight. Extra pounds put extra stress on your plantar fascia
     

If you still have pain after several weeks, see your podiatric surgeon, who may add one or more of these approaches:

  • Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia. 
  • Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis. 
  • Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain. 
  • Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal. 
  • Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients. 
  • Physical therapy. Exercises and other physical therapy measures may be used to help provide relief

Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your podiatric foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you. 

Long-term Care 

No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. If you are overweight, it is important to reach and maintain an ideal weight. For all patients, wearing supportive shoes and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis. 
 

This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons. Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards. Copyright © 2004, American College of Foot and Ankle Surgeons • www.acfas.org

If you are experiencing heel pain, Foot and Ankle Associates of New Mexico can help! Call us to schedule an appointment. Find out more about our office and becoming a new patient:  New Patient Information.

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