Heel pain one of is the most common conditions we treat and can be caused by many different conditions. It can occur in people of all ages and fitness levels and may be acute or chronic in nature.
Very often a heel spur is associated with or spoken about as the same injury as plantar fasciitis. A heel spur is a boney growth under the heel bone at the attachment of the “arch muscle”. For a heel spur to develop, the underlying cause has to have been present for many years. Biomechanical anomalies with the foot are often the base cause but the presence of a spur does not indicate the severity of your heel pain and often the worst cases of plantar fasciitis have no spur formation.
The plantar fascia is a strong ligament that runs the length of your foot from the heel bone to the toes. Although it is strong, it is not very elastic, so repeated movements, such as running, can overstretch it and partially tear or pull it away from the heel bone. The plantar fascia can also overstretch or tear at the arch.
Usually, the symptoms begin gradually, but after several weeks, the pain gets worse and does not diminish. Generally, there is no swelling or bruising in the area. However, you may feel tenderness when you apply deep pressure to the heel pad or the arch.
Plantar fasciitis and many other heel conditions are caused by damage to the tissue that connects into the heel or mid foot. This damage causes inflammation.
When you walk around during the day, the act of walking with muscles contracting and pressure from the ground pressing on the heel acts like a massage and prevents inflammation from building up in the heel. But if you lay down at night or sit down for a while during the day, you stop doing those actions that prevent the build-up of inflammation. The inflammation builds up and then when you go to stand up again, you have a sharp pain in your heel due to the extra inflammatory fluid in the area. You then walk around for a few minutes, the inflammatory fluid is pumped out of the area and you feel better – at least for a while.
In normal functioning of the heel, the plantar fascia acts as a shock absorber and support mechanism for the arch of the foot. During gait, or movement, the plantar fascia acts like a spring which winds and unwinds to conserve energy and provide propulsion. Tension increases while the foot is on the ground to store the energy and is then released during toe-off to help with acceleration.
Plantar fasciitis literally means inflammation of the plantar fascia, but most cases are more degenerative changes rather than inflammatory ones. A new term being used to accurately describe the condition is plantar fasciosis. In most cases the pain is on the under surface of the foot at the junction of the plantar fascia and the heel bone know as the calcaneus. The condition accounts for about 10% of runner related injuries and is twice as predominant in women than in men. Because of this high incidence in runners, micro trauma from repeated stress is believed to be the primary base cause.
Plantar fasciitis may go away on its own, with rest, but it may take several months or longer to resolve completely. There is treatment to help you recover faster.
Heel Pain has a number of symptoms that include:
We usually diagnose heel pain by asking you about your symptoms and physically examining your foot. At the footinjuryclinic we have state of the art video gait analysis and pressure fluoroscopes which we use in aiding our diagnosis. We may order an imaging study, such as an X-ray, if we suspect that your symptoms may be caused by another condition, such as a stress fracture, but this is rare.
There are a number of factors that can increase the likelihood that you will develop heel pain including:
There are a number of things you can do to protect your feet and prevent injury to your plantar fascia:
It may take 3 to 12 months for your plantar fascia to heal completely. We recommend using a number of treatment approaches simultaneously, home and medical. It is important that you continue treatment until you have been pain-free for at least 3 months.
We may recommend a cortisone injection to reduce inflammation and accompanying pain. Cortisone is a steroid that mimics natural hormones that reduce inflammation.