Plantar Fasciitis—Plantar fasciitis or heel pain, sometimes called heel spur syndrome (when a small bony spur may be seen on x-ray protruding from the heel ) is a common condition affecting millions of people annually. It is often described as a sharp, aching, or bruise-like pain on the bottom of the heel that is felt when standing or walking and often with the first steps out of bed in the morning or when getting up out of a chair later in the day. It tends to get worse as a day progress and as people spend long hours on their feet. Usually there is no inciting injury or event…it just starts to happen.
Is heel pain serious?
The short answer is no…..it’s seldom a surgical issue and usually does not require a trip to the emergency room. HOWEVER, it can be VERY painful (as you know if you have it), even debilitating at times making normal everyday tasks difficult or virtually impossible. For most people it’s a genuinely painful condition and more than just a nuisance. The seriousness comes when the pain is limiting normal activity for extended periods of time.
Why does it occur?
There is still debate as to exactly why the heel pain starts….and there’s even more debate as to what exactly is causing the pain. Traditionally called “fasciitis”, this term implies an inflammation of the plantar fascia (a long broad ligament that spans the bottom of the foot and helps to support the arch) where it attaches at the heel bone (calcaneus). However, studies have shown that the bodies typical inflammatory cells are usually not abounding in this area and thus some would rather call it a plantar “fasciosis” meaning a “degeneration or deterioration” of the plantar fascia instead. Either way, it hurts, and overuse seems to be a likely culprit. Multiple other factors have also been been well correlated such as a flat foot or (pronated foot), a high arched foot (cavus foot), overuse, poor shock absorption, barefoot walking, non-supportive shoes…and the list goes on. THE REALITY is that we see this in people of almost all ages (usually beyond about 25-30) and body sizes and often a specific cause cannot be identified….it just happens.
Is there anything I can do at home to get better?
YES…that’s the good news. There are many things that are easy to try on your own which may help resolve your pain…see below
1. AVOID barefoot walking while you are recovering. Someday you can probably go back this this habit, however, it seems to perpetuate the problem and slow down recovery.
2. Wear supportive athletic shoes as much as possible, ideally a shoe that feels good and has some intrinsic arch support and good shock absorption.
3. Try applying some ice for 10-15 minutes when most painful. Don’t put the ice directly on the skin as this could cause injury.
4. START STRETCHING morning noon and evening! This may be the best “long term” treatment. You can view and print my Stretching Exercises on the Educational and Helpful Printouts page. Read and follow the instructions.
5. Try decreasing your time on your feet if possible….understandably, this suggestion may not be feasible for many people.
6. Give it some time as a full recovery may take several weeks.
What can we do to help get rid of your heel pain?
there are many things that we can do to help get rid of your heel pain, but they all start with a thorough history and exam to rule out more severe problems and evaluate for possible causes of the heel pain.
Below is list of some of the things more commonly recommended and/or prescribed for patient’s suffering from heel pain.
- posterior muscle/ Achilles tendon and plantar fascial stretching
- Icing/heat/contrast baths
- LowDye strapping of the foot to relieve tension off of the plantar fascial ligament and better support the foot
- Affordable PowerStep Shoe inserts we can dispense at our office same day as your appointment
- Custom molded orthotics or shoe inserts
- Prescribe and dispense Darco Pneumatic Night Splint (this device can really help reduce the morning pain and is well tolerated by most people)
- Cam Walker to rest the ligament in cases of severe discomfort or possible ligament strain or tear
- Prescribe oral antiinflammatory or steroid medications
- Administer heel injections to target the steroid affect at the source of the pain.
- Prescribe physicial therapy in difficult or recalcitrant cases of heel pain
- perform minimally invasive platelet rich plasma injections – reserved for patients who are otherwise looking at needing surgery
- Surgically releasing the plantar fascial ligament – reserved for those who have undergone a significant amount of conservative care and are still suffering…this should be a very last resort.
What are the risks?
NSAIDS—If you plan to take NSAIDS (non-steroidal anti-inflammatory) such as ibuprofen (Motrin) or naproxen (Aleve) you want to make sure you are healthy enough to do so and this may require consulting with your doctor. It is not totally uncommon for patients to start taking these medicines and then experience the negative side affects such as stomach upset, heartburn, gastric or intestinal bleeding, or liver or kidney problems. They cab also affect your blood pressure, so be careful and never take more than the recommended doses, and always seek medical attention if you are having any concerning side effects.
Heel injections—Heel injections also have their inherent risks including bruising, pain, infection, fat atrophy, skin atrophy, reaction to the medication, or it just might not work to reduce your pain. There are also well documented cases of partial or complete rupture of the plantar fascial ligament after injections have been given. Most people tolerate a heel injection very well. The skin is cleaned with rubbing alcohol and/or betadine, cold spray is used to numb the skin and the injection is then given from the side for minimal discomfort.
Orthotics and arch supports—A popular and frequently effective treatment for heel pain, these devises work to support the foot better and control abnormal forces. The greatest risk associated with an orthotic is that you may pay lots of money for it and it may not totally work for you. For this reason I typically recommend a pair of quality PowerStep shoe inserts at first. We price these to be quite affordable and find many people are very happy with them. Studies have shown that for most people with heel pain a non-custom orthotic will be just as effective as a custom orthotic. Nevertheless, in some patients who’s feet are more flat or who’s pain has continued despite OTC inserts, I do take impressions and write prescriptions for custom orthotics. They are more expensive but a quality pair can last 5-10 years with routine use and they do help a lot of people.
Platelet Rich Plasma Injections– This involves drawing some of your own blood and spinning in in a centrifuge to obtain the portion that contains the plasma and platlets. Platlets have significant ability to help heal injuries. The concentration of platlets can then be injected into the heel at the area of fasciitis. This procedure has been shown to help some patients with chronic fasciitis finally get better.
Heel Surgery – Surgery for chronic fasciitis is only considered as a treatment of last resort after multiple more traditional and less invasive treatments have failed to provide relief. Surgery for chronic heal pain often involves cutting or surgical releasing a portion or all of the plantar fascial ligament. If a very large spur is present somtimes this is also removed. NOTE: There are risks with surgery such as infection, wounds, swelling, bleeding, nerve injuries, continued pain, and others risks which would be reviewed with you personally if you were to be undergoing surgery for chronic fasciitis.
What is the prognosis?
For the majority of people who have plantar fasciitis or heel pain, the prognosis is quite good. Often with a simple change in activity level or shoes it may even resolve on it’s own….(if you are still reading you’re probably mumbling to the computer….”yeah…wouldn’t that be nice but it hasn’t!”). For those who have tried some of the simple home treatments yet continue to have pain, it may be time to make an appointment to come see us. Sometimes it takes 2 or 3 visits to get things turned around, but we usually do, and for that your feet will thank you.