Posted by
Dr. Paden on Thursday, July 13, 2006 2:47:12 PM
Whether you call it "heel spur syndrome"or "plantar fasciitis", heel pain is easily the most common ailment we treat in our podiatry practice.
Plantar fasciitis is inflammation of the ligament on the bottom of the foot. It most often causes pain in the heel, but can manifest as pain along any portion of the sole. Symptoms are commonly most pronounced with the first steps in the morning, but may also continue throughout the day or become worse with prolonged activity. The severity of the pain may range from a dull, barely noticeable ache to a severe, nearly disabling stab. Patients rarely recall an inciting injury or event although we do occasionally see traumatically induced plantar fasciitis. Rarely will plantar fasciitis be accompanied by redness, heat, or swelling. If any of these are present, a more serious condition (such as stress fracture or ligament rupture) may be present, and requires more immediate medical attention.
Before seeking professional care, mild heel pain may respond to some simple home therapies. I always recommend avoidance of barefooted walking, some gentle stretching exercises, and usually ice application. Typically high impact activities (treadmill running or jump roping for example) should be avoided until symptoms subside.
In healthy adults, often anti-inflammatory medications are prescribed for a 10-14 day course. When those fail, or the patient requires more immediate relief, a steroid injection may be curative. The injection does hurt and may make the pain worse for several days, but in many cases it's the most successful treatment.
Some people are predisposed to develop plantar fasciitis because of their foot type. A very rigid high arched foot absorbs shock poorly, and that shock is transferred to the ligament, increasing the risk of injury. On the flip side, an unstable flat foot may result in excessive tension on the ligament, also inducing inflammation. Even in a perfectly "neutral" foot, activities such as long distance running or working at a job which requires hours of standing on hard surfaces can cause plantar fasciitis. No wonder it's the most common pathology we treat!
More often than not, we recommend either an over-the-counter or custom foot orthotic to either stabilize the arch (in an unstable flatfoot) or improve shock absorption (in the rigid foot) and increase our long term success in treating heel pain. There are many excellent OTC supports, most of which run thirty to forty dollars. Beware any nonprescription device that will cost you several hundred dollars and for which there is no refund available. Buyer beware.
Rarely, in fact in fewer than 5 % of cases, do we need to operate on plantar fasciitis. Some patients have been led to believe that because they have a bone spur visible on xray, they need surgery to remove it. We know that the presence of a "heel spur" rarely correlates to the severity or longevity of the symptoms. So called "heel spurs" should be treated in the identical manner as plantar fasciitis, with surgery being scheduled only after all conservative measures have been exhausted. Successful conservative measures may also include night splints, physical therapy and shock wave therapy. Each has its place in the treatment of heel pain, and all should be considered before surgery in most cases.
Plantar fasciitis may last several months or even years, so it's worth treating aggressively from its onset. If nothing else, get a good pair of sports sandals to wear around the house and see if it doesn't start getting better pretty quickly. If not, your local podiatrist will be happy to see you. And the other five people he'll see that day with the same problem!