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Heel Pain / Plantar Fasciitis Explained in Detail

Plantar Fasciitis or as it is more commonly refferred to heel pain is one of the most common conditions treated by podiatrists. Pain is often a message from the body that something is in need of medical attention.

Since the popularity of keeping fit and primarily running and walking has exploded the numbers of heel pain problems has also increased. This is largely due to the fact that when faulty foot mechanics are coupled with an increase in activity the wear and tear on the foot as a unit is increased and pain and deformity result.

Who Gets Heel Pain?

The greatest incidence of heel pain is seen in middle-aged men and women who are generally active. It is also seen in those who take part in regular sporting activities, those who are significantly overweight and those on their feet continually.

The Cause of Heel Pain?

While heel pain has many causes, it is usually the result of faulty biomechanics (abnormalities in the way we walk). This places too much stress on the heel bone and the soft tissues attached to it.

The stress may also result from injury, a bruise while walking, running or jumping on hard surfaces, wearing poorly constructed or old shoes or being significantly overweight.

Systemic diseases such as arthritis and diabetes can also contribute to heel pain.

Common Complications That Cause Heel Pain

Both heel pain and heel spurs are associated with inflammation of the long band of tissue that connects the heel and the ball of the foot (the plantar fascia). The role of the plantar fascia is to limit the flattening out of the foot. With excessive pronation (rolling in) the foot flattens, which strains the plantar fascia and leads to inflammation. Inflammation of this area is called plantar fasciitis.

Plantar Fasciitis or Heel spurs are a bony growth under the heel bone. About 10% of people with heel spurs have no pain associated. Heel spurs result from strain of the muscles in the foot in much the same was as the plantar fascia is strained. The strain on these muscles cause there to be excess pressure and pulling on the plantar surface of the heel (calcaneus) where they attach which causes a heel spur to form.

Other causes of heel pain

• Excessive rolling in of the feet
• An inflamed bursa (bursitis) small sack of fluid at the back of the heel – this is usually caught and irritated between the plantar fascia and the calcaneus as the arch collapses.
• A neuroma (nerve growth)
• Other soft tissue growths
• Enlarged back of the heel bone
• Bruises or stress fractures of the heel bone.

Treatment of Heel Pain

Rest – activity should be limited to those, which are unlikely to aggravate the injured site such as swimming and cycling.

Ice – ice will help reduce bleeding in to the area and will also help to reduce pain involved with the injury. Ice should be applied for 10 minutes 3 times per day for the first 72hrs. Ice should also be applied following activity.

Anti-inflammatory medication - will also reduce the pain and inflammation associated with the injury and will speed up recovery. Anti-inflammatory medication can be purchased over the counter from your chemist (Neurofen).

Strapping – helps to rest the injured site without limiting your activity. Strapping is also used to temporarily correct any mechanical abnormality in foot function. If strapping has reduced the amount of heel pain then an orthotic can be used as permanent measure.

Stretching & Strengthening – stretching of the calf muscle group helps to relieve the tension on the plantar fascia in walking and at rest by allowing the foot to function properly.

Orthotics – used when there is a mechanical deformity in the bony structure of the foot (usually rolling in). Orthotics balance the foot which allows it to function more efficiently which relieves the strain on the plantar fascia.

Night Splints – used to stretch the calf muscle groups while you sleep. These are used if conventional stretching is ineffective.

Cortisone Injection – usually used in long standing cases of heel pain that have responded poorly to the above treatments

Surgery – is used when all of the above treatments have failed to relieve pain in the heel. This usually involves removing the plantar fascia from the heel bone.

Recovery

Your recovery will depend on the nature of your heel pain and your individual health. Recovery of course depends on the duration the condition has been untreated for and your compliance to the treatment methods outlined above.

In a small number of cases conservative treatment of plantar fasciitis is unsuccessful and cortisone injections followed by surgery may be necessary.