Heel pain that occurs on the bottom of a patient’s heel is often caused by an abnormal and excessive pull of the plantar fascia (arch muscle) at its insertion. Pain in the plantar fascia is often at times associated with an increase in activity (exercise), or weight gain and is commonly found in adults of all ages. Morning pain and pain when walking after periods of rest, are common first signs of this condition, which can progress to pain whenever a patient ambulates.
Diagnostic testing including X-Rays and Fluroscopy are indicated when a patient has heel pain to ascertain whether an arthritic bone (heel spur) contributes to the patient’s painful symptoms. Diagnostic Ultrasound is also indicated when plantar fasciitis is suspected to determine the thickness of the plantar fascia, as well as to check that there are no tears in the fascia.
Treatment is aimed at eliminating the inflammation in the plantar fascia and supporting the longitudinal arch of the foot to reduce the strain on the fascia, and is effective in over 90% of patients with heel pain. Conservative treatments include cortisone injections, physical therapy, oral anit-inflammation medications, stretching exercises, strapping and padding of the heel, and the fabrication of custom orthotics (shoe inserts) to stablize the patient during their gait (walking) cycle. Custom orthotics can also accommodate heel spurs by off-loading the area of the insertion of the plantar fascia.
When conservative treatments fail, other “minimally” invasive treatments are available. Radiofrequency therapy uses radio waves to block pain signals in the heel, and does not require incisions or stitches. PRP (Platelet Replacement Plasma) utilizes autogenous platelets extracted from the patients own blood, which when re-injected into the heel enhances healing and reduces and often eliminates all painful symptoms when necessary. An EPF (Endoscopic Plantar Fasciectomy)can be performed through a very small incision, where the plantar fascia is elongated, which reduces the pull on the plantar fascia. When necessary an open procedure is performed to lengthen the plantar fascia and eliminate a heel spur at the same time. Surgical patients wear custom orthotics after the procedures to support the arch and reduce the strain on the fascia.
Patients with Achilles tendon pain have pain on the back of their heels which is associated with “over stretching” the tendon. Patients with Achilles tendonitis pain tend to have flat feet which increases the tension on the tendon. When the Achilles tendon is palpated (touched) with these patients, the tendon feels taught (tight). Patients with pain on the back of their heels often hurt when they ambulate in flat shoes and when their feet are dorsiflexed, (stretched upward) as the strain on the Achilles tendon is over stretched during these events.
Diagnostic Imaging including X-Rays and Fluroscopy are indicated with these patients to confirm the presence of generalized arthritic changes in the back of the calcaneus, (back of the heel) or to search for a spur Haglund’s Deformity (a bump on the back of the heel bone). Diagnostic Ultrasound is also used to determine the thickness of the Achilles tendon. A tendon’s thickness corresponds to the level of inflammation in the tendon.
Conservative treatment of Achilles tendonitis includes physical therapy, oral anti-inflammation medications, padding of the painful area of the heel, heel lifts to reduce the pull on the tendon, and custom fabricated orthotics to lift and balance the patient during their gait cycle. Cortisone injections may weaken the attachment of the Achilles tendon to the heel bone, and are not commonly used when treating Achilles tendonitis. When the heel bone is involved, surgery is also another possible option when conservative treatment fails to alleviate the patient’s painful symptoms.