One of the most common foot problems that we see in our office is heel pain. Many patients of all ages, from the very young to the very old to the in between, have all had heel pain at some point in their life. Patients often complain by stating “I'm having sharp stabbing pains in my heel”. Heel pain is a very devastating condition that can take people out of their normal life's activities. This especially is a problem for people who have to work on their feet or stand for long hours due to their daily routines. The good news is that with some very simple treatment, we can make this problem go away. Heel pain is caused by numerous reasons however; plantar fasciitis is probably the most common.
Plantar fasciitis presents with random onset with sharp pain along the course of the bottom of the foot at the arch. Swelling and numbness may also be present. Patients also usually have a very stiff Achilles and the fascia is tightened as well.
This condition is frequently diagnosed when patients tell us that their first steps out of bed in the morning, or their first steps up on their feet after sitting for a period in a chair causes excruciating pain on the bottom of their heel. The plantar fascia is a band of thick fibrous tissue that is similar to the string of bow (a bow like the one used in archery). If you imagine putting that string on the floor and then putting pressure on the curved piece of wood of the bow and pressing down you can see how that puts stretch and tension and pulls on that string. This is what happens to people who have plantar fasciitis.
Flat feet, which are feet with very low collapsed arches, are the feet that very often develop plantar fasciitis. As this ligament of tissue is pulled out of its insertion on the bottom of the heel, the tissue becomes damaged, inflamed, and can even eventually lead to a bone spur or heel spur. Flatfeet are feet that are excessively loose and do not have the structure to support the arch.
The development of heel spurs can be a sign of chronic plantar fasciitis that has gone untreated. A heel spur is a growth of bone that extends from the heel bone (calcaneus), and can only be seen on x-ray. The calcaneus is the largest bone in the foot and absorbs the most amount of shock and pressure, hence the development of the spur. Heel spurs peak in people between the ages of 40 and 60 years in the general population and in younger people among runners. Some studies show that men and women are equally affected.
Treatment is as usual; low-dye taping, ice massage and some type of arch support. Following the acute phase, phonophoresis may be helpful. Plantar fascial and achilles stretching via plantar fascial splint or other technique should be instituted and are the most essential elements. Corticosteroid injections may be needed for immediate pain relief, however it is very temporary and rarely does it ever truly solve the issue. Proximal plantar fasciitis, otherwise known as “heel spur syndrome” commonly accompanies plantar fascitis, although it may occur alone. The same mechanical influences as with plantar fascitis usually exist.
Other people who can develop plantar fasciitis are those who are overweight or have excessively high arched feet. I frequently see people develop pain in their heels because of changes in their lifestyle over a period of time that puts the foot in a poor environment. People who walk around the house barefoot, people who go on vacation and wear sandals or flip-flops and do a lot of walking, or people who start an exercise program without proper pacing are all examples of people who can develop plantar fasciitis.
Many people ask if surgery is necessary for plantar fasciitis relief. The most remarkable thing is that almost everyone who comes to the office can be cured of their heel pain without resorting to any type of surgery. However surgery may be necessary in stubborn cases. They want to know how we can help the problem that has been affecting their quality of life, and we offer many conservative treatments. The most important thing is a complete clinical examination of the feet and lower extremities to help ascertain all of the causes involved with their pain. Once the exam is done, x-rays are frequently suggested to look for a heel spur, which often occurs when someone has developed plantar fasciitis.
Some of the simple things that we do are detailed education about proper footwear. By recommending the proper shoe, we can help relieve stress on the painful plantar fascia and heel in many cases. We also offer temporary strappings of the foot with tape to support the arch.
Here is an educational video on plantar fasciitis:
Many effective conservative treatments are;
- corticosteroid injections
- ice massage
- low-dye strappings
- stretching exercises
- diagnostic ultrasound
- ESWT (Extracorporeal shockwave therapy)
If you are experiencing these symptoms you can start with wearing the properly fitting and type shoe, and icing the area along with stretching. If your pain persists, you should seek the opinion of a professional, Dr. Theall or Dr. Seshie. They will be able to provide you with the proper treatment and evaluation of the foot pain you are experiencing. Feel free to come or call Dr. Theall and Dr. Seshie's office, Gentle Touch Foot Care for a full comprehensive and thorough evaluation to discuss your foot health.
For more information, contact our East Orange office at 973-673-FOOT (3668).