Heel Pain - Plantar Fasciitis

The heel bone (calcaneus) is surrounded by a specialized envelope of fatty tissue called the heel pad. The heel pad has a certain sponginess or resiliency. It consists of multiple, specialized fat cells located in small compartments to maintain the cushioning of the heel during walking and standing. There are a number of ligaments that attach to the bottom of the heel. It is inflammation of these ligaments that commonly gives rise to a condition called plantar fasciitis.

Plantar fasciitis involves microscopic tearing of one of the ligaments that attaches to the underside of the back of the heel. It is a common condition and frequently present in women who are overweight. It is also associated with certain foot types as well as repetitive, strenuous activity that may cause bruising and inflammation of the back of the heel. 

Patients with plantar fasciitis typically experience heel pain in the early morning when they arise. As the foot is put down on the ground there is a sudden, searing sensation on the back of the undersurface of the heel. 

The pain continues and as the foot stretches out a little bit with walking, some of the pain subsides. Typically this improves slightly, only to worsen again as standing and walking increase over the course of the day.

The diagnosis of plantar fasciitis is confirmed by very specific examination of the back of the heel related to the location of the pain under the heel. There is often a nerve that is simultaneously inflamed or pinched underneath the fascia. This can aggravate the pain even further.

Plantar fasciitis treatment is designed to cushion the heel, stretch out the fascia and support the arch of the foot. The main treatment for plantar fasciitis involves cushioning the heel with a silicone heel pad.

Stretching exercises for the back of the heel are done on a regular basis, two to three times daily. Stretching out the foot at night using a specially designed night splint or brace maintains the foot in a straight up position. This prevents it from dropping down during the night.

The natural position of the foot during sleep rests the fascia, which then is subjected to vigorous stress again when getting up and walking in the morning. Keeping the fascia stretched at all times (but particularly at night) seems to help. If these methods of treatment fail, a cortisone injection into the back of the heel often will reduce the inflammation.

More than one cortisone injection is not a good idea because it weakens the heel pad and can even aggravate the condition. If none of these treatments are sufficient, the next alternatives are shock wave therapy or surgery.

Shock wave therapy is a unique treatment where a high frequency, ultrasound impulse is transmitted to the back of the heel to break up the scarring. (Similar treatments are used to treat kidney stones.)

Alternatively, surgery may be performed through a small incision on the back of the heel to release the plantar fascia and, in some cases, release the nerve that is pinched at the same time. The treatments are highly effective in relieving the chronic pain if cushioning, stretching and immobilization fail.