Heel pain is a very common foot problem. The sufferer usually feels pain either under the heel (planter fasciitis) or just behind it (Achilles tendinitis), where the Achilles tendon connects to the heel bone. Even though heel pain can be severe and sometimes disabling, it is rarely a health threat. Heel pain is typically mild and usually disappears on its own; however, in some cases the pain may persist and become chronic (long-term).
Plantar fasciitis is caused by inflammation and irritation of the tight tissue forming the arch of the foot. The most common cause of heel pain, it typically affects men, aged 40 - 70 who are physically active. The bottom or inside of the foot and / or heel (where heel and arch meet) may hurt or cause severe pain upon standing after resting -- or most often, when arising in the morning. The pain is usually experienced within the first few steps and is often characterized as "walking on nails" or knife blades. The pain may let up after walking a bit but most commonly returns after prolonged movement or a rest.
Initially, this pain may only be present when first standing up after sleeping or sitting. As you walk around, the muscle and tendon loosen and the pain goes away. As this problem progresses, the pain can be present with all standing and walking. You may notice a knot or bump on the back of the heel. Swelling may develop. In some cases, pressure from the back of the shoe causes pain.
To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
Non Surgical Treatment
Treatment options for plantar fasciitis include custom prescription foot orthoses (orthotics), weight loss when indicated, steroid injections and physical therapy to decrease the inflammation, night-splints and/or cast boots to splint and limit the stress on the plantar fascia. Orthotripsy (high frequency ultra-sonic shock waves) is also a new treatment option that has been shown to decrease the pain significantly in 50 to 85 percent of patients in published studies. Surgery, which can be done endoscopically, is usually not needed for over 90 percent of the cases of plantar fasciitis. (However, when surgery is needed, it is about 85 percent successful.) Patients who are overweight do not seem to benefit as much from surgery. Generally, plantar fasciitis is a condition people learn to control. There are a few conditions similar to plantar fascia in which patients should be aware. The most common is a rupture of the plantar fascia: the patient continues to exercise despite the symptoms and experiences a sudden sharp pain on the bottom of the heel and cannot stand on his or her toes, resulting in bruising in the arch. Ruptures are treated very successfully by immobilization in a cast boot for two to six weeks, a period of active rest and physical therapy. Another problem with prolonged and neglected plantar fasciitis is development of a stress fracture from the constant traction of this ligament on the heel bone. This appears more common in osteoporotic women, and is also treated with cast boot immobilization. The nerves that run along the heel occasionally become inflamed by the subsequent thickening and inflammation of the adjacent plantar fascia. These symptoms often feel like numbness and burning and usually resolve with physical therapy and injections. Patients should also be aware that heel numbness can be the first sign of a back problem.
If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints or a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as open surgery, where the section of the plantar fascia is released by making a cut into your heel or endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team.
heel cushion silicone
A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don't underestimate your body's need for rest and good nutrition. If obese, lose weight.