Heel Pain / Plantar Fascitis

When your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis (fashee-EYE-tiss). It's an overuse injury affecting the sole or flexor surface (plantar) of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes. You're more likely to get the condition if you're a woman, if you're overweight, or if you have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches are also more prone to plantar fasciitis. You're more likely to feel it after (not during) exercise. The pain classically occurs again after arising from a midday lunch break similar to that of the pain experienced with the first steps in the morning. If you don't treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity and you may also develop symptoms of foot, knee, hip and back problems because of the way plantar fasciitis changes the way you walk.

Rest is the first treatment for plantar fasciitis. Try to keep weight off your foot until the inflammation goes away. You can also apply ice to the sore area for 20 minutes three or four times a day to relieve your symptoms. Often a doctor will prescribe nonsteroidal anti-inflammatory medication such as ibuprofen. A program of home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treating the condition and lessening the chance of recurrence. About 90 percent of people with plantar fasciitis improve significantly after two months of initial treatment. You may be advised to use shoes with shock-absorbing soles or fitted with a standard orthotic device like a rubber heel pad.

If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). If you still have symptoms, you may need to wear a walking cast for 2-3 weeks or positional splint when you sleep. In some cases refractory to all of the above management options, a procedure called “shock wave therapy” for the heel may be beneficial. Rarely, surgery is necessary to release the plantar fascia ligament.

Not all heel pain is plantar fasciitis. As a matter of fact, many patients that do not improve may have been misdiagnosed and are suffering from another condition causing pain in the heel. These include tarsal tunnel syndrome (a nerve entrapment in the foot), atrophy of the tissue (loss of the normal heel pad), other pinched nerves in the foot, stress fracture of the calcaneus (heel bone), and other conditions. Although the majority of these disorders require only conservative treatment, the treatment options are slightly different and should be particularly rendered to address these conditions.

Modified from the AAOS