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Heel Pain

Heel Pain

Heel pain is most often caused by plantar fasciitis, a condition
that is sometimes also called heel spur syndrome when a spur is present.
Heel pain may also be due to other causes, such as a stress fracture,
tendonitis, arthritis, nerve irritation, or, rarely, a cyst.

Because there are several potential causes, it is important to have
heel pain properly diagnosed. A foot and ankle surgeon is able to
distinguish between all the possibilities and determine the underlying
source of your heel pain.

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 this condition, the fascia first becomes
irritated and then inflamed, resulting in heel pain.

Causes
The most common cause of plantar fasciitis
relates to faulty structure of the foot. For example, people who have
problems with their arches, either overly flat feet or high-arched feet,
are more prone to developing plantar fasciitis.

Wearing non-supportive footwear on hard, flat surfaces puts abnormal
strain on the plantar fascia and can also lead to plantar fasciitis.
This is particularly evident when one’s job requires long hours on the
feet. Obesity may also contribute to plantar fasciitis.

Symptoms
The symptoms of plantar fasciitis are:

Pain on the bottom of the heel
Pain that is usually worse upon arising
Pain that increases over a period of months

People with plantar fasciitis often describe the pain as worse when
they get up in the morning or after they’ve been sitting for long
periods of time. After a few minutes of walking the pain decreases,
because walking stretches the fascia. For some people the pain subsides
but returns after spending long periods of time on their feet.

Diagnosis
To arrive at a diagnosis, the foot and
ankle surgeon will obtain your medical history and examine your foot.
Throughout this process the surgeon rules out all the possible causes
for your heel pain other than plantar fasciitis.

In addition, diagnostic imaging studies such as x-rays or other
imaging modalities may be used to distinguish the different types of
heel pain. Sometimes heel spurs are found in patients with plantar
fasciitis, but these are rarely a source of pain. When they are present,
the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Non-Surgical Treatment
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:

Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
Ice. Putting an ice pack on your heel for
20 minutes several times a day helps reduce inflammation. Place a thin
towel between the ice and your heel; do not apply ice directly to the
skin.
Limit activities. Cut down on extended physical activities to give your heel a rest.
Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

If you still have pain after several weeks, see your foot and ankle
surgeon, who may add one or more of these treatment approaches:

Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
Orthotic devices. Custom orthotic devices
that fit into your shoe help correct the underlying structural
abnormalities causing the plantar fasciitis.
Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
Night splint. Wearing a night splint
allows you to maintain an extended stretch of the plantar fascia while
sleeping. This may help reduce the morning pain experienced by some
patients.
Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.

When Is Surgery Needed?
Although most patients
with plantar fasciitis respond to non-surgical treatment, a small
percentage of patients may require surgery. If, after several months of
non-surgical treatment, you continue to have heel pain, surgery will be
considered. Your foot and ankle surgeon will discuss the surgical
options with you and determine which approach would be most beneficial
for you.

Long-term Care
No matter what kind of treatment
you undergo for plantar fasciitis, the underlying causes that led to
this condition may remain. Therefore, you will need to continue with
preventive measures. Wearing supportive shoes, stretching, and using
custom orthotic devices are the mainstay of long-term treatment for
plantar fasciitis.

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