Heel pain is one of the most common complaints seen in the podiatrist's office. While there are many causes of heel pain, the problem is more often than not something called plantar fasciitis. To the general public, the outdated (and inaccurate) term "heel spur" is often used for this condition. While there may be a spur present, it is rarely the reason for the pain. Studies have shown that as many as 60 percent of people with no heel pain have spurs.

The plantar fascia is a thick band of tissue that originates at the heel bone, runs along the arch and inserts into the ball of the foot. Plantar fasciitis is inflammation of any portion of this tissue. The weakest link in this tissue is where it originates at the heel bone, and this is where most pain develops. The onset of pain is usually gradual and may develop following a period of over-activity, walking on hard surfaces, wearing unsupportive shoes, or walking barefoot. Patients have even developed plantar fasciitis from little more than having porcelain tile installed in the home. This unforgiving surface is notorious for causing heel pain.

Although excessive body weight can make any foot complaint more painful, it is not a major factor in the onset or perpetuation of this condition. Weight loss is only a small aspect to the treatment of plantar fasciitis.

Signs and Symptoms

The classic sign of plantar fasciitis is "first step pain". Pain is worse when the person stands up first thing in the morning or after sitting for a while. Walking causes the pain to subside, but it does not usually disappear completely. As the day progresses the pain may return and grow worse. The pain is usually not unbearable, and patients will often live with their pain for months if not years before seeking treatment. This is unfortunate as treatment is much more successful if started early. In addition, patients may make alterations in gait and stance to avoid pain, resulting in a series of secondary problems.

Treatment

Successful treatment of plantar fasciitis involves decreasing the inflammation around the heel and relaxing tight plantar fascial tissues pulling on the heel. Anti-inflammatory treatment plans often include oral NSAIDS,  ice, and rest.  In more persistent cases, decreasing the inflammation in the heel is best accomplished with a series of cortisone injections given weekly for three weeks. These shots are not as painful as they sound. The needle is very small, and the cortisone is mixed with a numbing agent.  In addition, prior to injection, the skin is numbed with a cold spray.

Stretching the plantar fasciitis is accomplished with a combination of the following:

1. Exercise to simply and easily elongate the plantar fascia at home.

2. Night splints to stretch the plantar fascia while you sleep.

3. The Heeler, a device specifically designed to provide ice massage directly to the plantar fascia.

For plantar fasciitis that does not respond to conservative care, a minor surgical procedure is available. The procedure involves releasing a portion of the plantar fascia from the heel bone.  This is performed endoscopically through two small quarter-inch incisions, and patients are usually walking in their own shoes again within four to five days.  The procedure is performed in an outpatient setting under mild sedation.

Plantar Fasciitis Exercises

Pain from plantar fasciitis can be easily treated from home with a few simple, easy to perform stretching exercises.

Stretching Exercise I

Standing with the ball of the foot on a stair, reach for the bottom step with the heel until a stretch is felt through the arch of the foot.

Stretching Exercise II

Position yourself as pictured, keeping the back leg straight with the heel on the floor and slightly turned outward.  Lean into the wall until a stretch is felt in the calf of the back leg.

Stretching Exercise III

Sitting in a firm chair, hold your leg straight out in front of you. Loop a towel (or belt) around the ball of the foot, holding one end of the towel in each hand.  Without bending your knee, steadily pull the towel toward you to stretch your calf muscle. Hold for 10 seconds, then relax.

Stretching Exercise IV

In a seated position, place The Heeler under the arch of the foot and roll the device back and forth with moderate pressure.