Got Heel Pain??

April 23, 2010
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Got Heel Pain??

I’m choosing to discuss heel pain during the month of April, National Foot Health Awareness Month, because it is an ailment that is seen again and again in any Podiatric practice and can usually be treated without surgery.

Heel pain syndrome, or Plantar Fasciitis, is irritation and inflammation of the foot’s plantar fascia: a band of tissue on the bottom of the foot that begins at the heel and fans out connecting into the toes. Picture a piece of rubber band along the bottom of your foot that with each step stretches and slacks, stretches and slacks. When the length of that piece of rubber band is too short or is stretched in the wrong direction, irritation can quickly result and heel pain becomes inevitable. Microscopic tears in the plantar fascia, resulting from this improper stretching, initiate the inflammatory and healing processes within the tissue.

Heel pain is often seen in patients with a flat foot because their plantar fascia is being stretched incorrectly. It can also be associated with unsupportive shoe wear, as the foot is not positioned optimally in a high heel or a flip-flop for example, and thus the plantar fascia can not function entirely as it was intended to.

When patients present to their Podiatrist complaining of heel pain, they will likely complain that pain is greatest with their first step out of bed in the morning and that pain decreases as they become more active throughout the day. The “First-Step” pain patients experience is called “Post-static Dyskinesia:” pain after periods without movement. As we said before, the plantar fascia tears microscopically leading to pain, inflammation, and with periods of rest, healing. When you step out of bed in the morning and stretch your plantar fascia, you re-tear all those areas of fascia that have started to heal, which is why that first step is so painful! As the day goes on, you tend to do more walking and moving around, and the fascia stretches and accommodates, resulting in slightly less pain than when you first awoke. Plantar fasciitis is a progressive syndrome, in that in the early months of heel pain patients are able to tolerate, but with each month that passes the pain increases, leading them to seek professional intervention by a Podiatrist!

Often, your Podiatrist will opt to take x-rays of your feet to rule out the possibility of fracture in addition to checking for a heel spur. It is important to note that a heel spur is not the cause of the pain, but more likely the spur is a result of the plantar fascia and other musculature of the leg and foot pulling on the heel bone. Often, heel spurs are an incidental finding and are not related to a patient’s complaint.

As for treatment, a variety of options can be explored and about 95% of patients with heel pain will experience relief without the use of surgical intervention! You will first be encouraged to wear supportive shoes at all times, helping to decrease unnecessary strain on the plantar fascia. You may also be given a series of calf and fascia stretching exercises to complete. Your plantar fascia pulls the heel bone in one direction and the muscle of the calf pull the heel bone in the opposite direction, thus when calf muscles are tight there is increased strain on the fascia. It may be recommended that a steroid be injected into the plantar fascia, which will attempt to break the inflammation cycle and encourage healing of the plantar fascia by your body’s own mechanisms. Ice, oral anti-inflammatory medications and limitations to activity are all additional things that are encouraged in order to rest the fascia and allow it to heal. Keep in mind that although 95% of patients will experience relief with conservative treatments, that relief may take several weeks to be realized – so be patient with your Podiatrist!

Surgery, as mentioned, is a LAST resort for patients with heel pain and even before invasive procedures are explored, there are options that are non-invasive. Some of which we will talk about in the coming weeks, including Acoustic Shock Wave Therapy; a treatment modality only offered by Advanced Foot Care Centers LLP of Chattanooga and North Georgia. Stay tuned or contact one of our offices ( if you can’t wait it out until next week!

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