Heel pain is one of the most common and
persistent foot problems affecting men and women of all ages. It originates
deep within the foot, directly on the heel bone, or within the foot’s
connective tissue -- the fascia. Pain occurs when tissues become irritated or
inflamed resulting in growth of small spurs on the heel bone.
Plantar fasciitis, the type of heel pain
caused by chronic inflammation of the connective tissue extending from the heel
bone to the toes, occurs most frequently in adults. Being overweight and
wearing inappropriate footwear are common contributing factors. The pain is
most noticeable after getting out of bed in the morning, and it tends to
decrease after a few minutes and returns during the day as time on the feet
Many patients attempt self remedies for heel
pain, such as anti-inflammatory medications and over-the-counter heel pads,
before seeking medical advice. To help diagnose the origin of heel pain,
physicians take a thorough history to learn the time of day when the heel pain
occurs, types of shoes worn most frequently, activity levels at work or during
recreation, and if there has been any recent trauma to the area.
Not all heel pain, however, is caused by
plantar fasciitis. It also can occur from inflammation of the Achilles tendon,
bursitis, arthritis, gout, stress fractures, bone or soft tissue tumors, or
irritation of one or more of the nerves in the region. Sometimes in such cases,
heel pain could be a symptom of a serious medical condition that should be
diagnosed and treated separately.
Clinical guidelines published by the American
College of Foot and Ankle Surgeons help physicians diagnose and manage all
types of heel pain and distinguish cases that should be treated conservatively
from those that require more specialized care.
Non-Surgical Treatment Works
Initial treatment options for heel pain caused by plantar fasciitis include
anti-inflammatory medications, padding and strapping of the foot and injections
of corticosterioids. Patients also should stretch their calf muscles regularly,
avoid wearing flat shoes and walking barefoot, use arch supports and heel
cushions, and limit the frequency of extended physical activities.
Most patients with plantar fasciitis respond
to non-surgical treatment within six weeks. If improvement occurs, initial
therapy is continued until the heel pain is resolved. But if heel pain
persists, the patient should be referred to a foot and ankle surgeon for
further evaluation and more specialized treatment.
Treatments for Persistent Heel Pain
When non-surgical treatment fails to remedy heel pain, surgical options may be
several surgical and non-surgical treatment alternatives available, heel pain
should not be tolerated as a consequence of aging, injury, disease or regular
physical activity. For those with persistent heel pain, foot and ankle surgeons
are the experts to consult for determining the most appropriate treatments. The
surgical treatment options for plantar fasciitis are generally focused on
release of the tight and chronically inflamed plantar fascia bands. This can be
performed either thought a minimally invasive endoscopic approach or thought a
small incision on the inside of the heel. Surgical treatment of other causes of
heel pain are focused on addressing the underlying cause of the heel pain. Bone
or soft tissue tumors can often be removed without causing much complication or
requiring extended recovery. Nerve entrapments around the heel can easily be
decompressed allowing for return to pain free ambulation in a short period
after the surgery. Regardless of the underlying cause of the heel pain, a foot
and ankle surgeon is the most appropriate physician to seen for evaluation and
treatment of the pain.