What you need to know about heel pain

Very common in adults and on the rise in children, heel pain continues to be the number one reason patients seek care from foot and ankle surgeons. While experts say there are many reasons for heel pain, including bursitis, Achilles tendonitis, bone bruises, fractures, growth spurts and nerve pain, the most common cause is plantar fasciitis, a condition that one in 10 people will suffer from in their lifetime.

According to the American College of Foot and Ankle Surgeons (ACFAS), plantar fasciitis can have serious repercussions if left untreated. Here’s what to know:

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 in which the fascia becomes irritated and then inflamed. Symptoms include pain on the bottom of the heel, pain in the arch of the foot, and swelling on the bottom of the heel. For many, the pain is worse upon arising and increases over a period of months.

A telltale sign of mechanical issues in the foot, those with overly flat feet or high-arched feet are more prone to developing plantar fasciitis. Lifestyle factors can also play a role. Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia. This is particularly evident when one’s job requires long hours on the feet. Obesity and overuse may also contribute to plantar fasciitis.

How is it Treated?

“We typically treat plantar fasciitis conservatively, at first,” said Michael J. Cornelison, DPM, FACFAS, a foot and ankle surgeon and president of the American College of Foot and Ankle Surgeons. “This can include a combination of remedies, including rest, exercises that stretch the calf muscles, orthotics, icing the heel, over-the-counter medications like ibuprofen, supportive footwear and physical therapy.”

Most patients respond well to conservative treatments. However, depending on the severity of the plantar fasciitis, additional therapies may be required, including:

• Injection Therapy: Growth factor injections and platelet rich plasma injections are used to boost the body’s healing response and help repair injured tissue.

• Shockwave Therapy: This in-office treatment uses sound waves delivered over the skin to slightly damage the tissue and stimulate the body’s natural repair process. This helps the plantar fasciitis heal and relieves pain symptoms without making an incision. Patients can expect to be up and moving immediately after treatment, but it may take three to six months to see results.

• Ultrasonic Treatment: In this newer procedure, a small incision is made into the heel of the foot and a probe directs ultrasonic energy at the fascia to break down bad tissue and help the healing process. A diagnostic ultrasound tool is used to create an image of the inside of the foot and guide the probe. Patients may need to wear a boot immediately after the procedure for up to two weeks and they can expect to see improvements anywhere from three to six months after the procedure.

• Surgery: Also called a plantar fasciotomy, this minimally invasive, minimally traumatic surgical treatment involves making a small incision through the heel into the damaged tendon to try to lengthen it and relieve tension. Patients tend to recover in six to 10 weeks, but it may take up to three months to resume exercise and more vigorous activities.

No matter what kind of treatment a patient undergoes, the underlying causes that led to the condition may remain. Preventive measures, such as wearing supportive shoes, stretching and using custom orthotic devices, are the mainstay of long-term treatment for plantar fasciitis.