Heel pain is one of the most common complaints among our patients, and it’s no wonder – the feet take on 60 tons of stress for every mile you walk. Your feet can handle a lot of strain, but if they are overworked, you may experience heel pain.
Heel pain is a stressful condition that affects day-to-day activities. It can be caused by several conditions, but plantar fasciitis is the most common cause of heel pain.
What Is Plantar Fasciitis?
A long, thin ligament called the plantar fascia is located right underneath the skin at the bottom of the foot, connecting the heel to the front of the foot. The plantar fascia helps supports the arch of the foot, and can withstand a lot of the stress we put on our feet. However, sometimes we may overwork our feet, resulting in inflammation and pain known as plantar fasciitis.
While we can’t always pinpoint a specific cause for plantar fasciitis, risk factors may include a high or low arched foot; activities that require repetitive impact on the feet, like running or other sports; and any new or increased activity. Tight calf muscles can also be a risk factor, if the muscles are so tight that it is difficult to flex your foot. Ill-fitting, unsupportive shoes or changes in weight may also contribute to plantar fasciitis.
Symptoms of plantar fasciitis include pain at the bottom of the foot near the heel, pain with the first few steps after a period of rest, and pain that increases after physical activity.
Many people with plantar fasciitis also have calcium deposits, called heel spurs, which form where the fascia tissue band connects to the heel bone, but these spurs are not the cause of heel pain. A heel spur occurs when the tissues of the plantar fascia undergo a great deal of stress, stretching the ligament, and pulling some flecks of calcium into the fascia. These deposits show up on an x-ray as a heel spur, but do not affect the prognosis or treatment of the condition.
What Is Achilles Tendinitis?
The Achilles tendon is a very strong tendon that inserts into the back of the heel, assisting in ankle motion. There are three calf muscles that converge into the Achilles tendon, and they are some of the strongest muscles in the body. When these muscles get worked through exercise, they become even more powerful and pull the Achilles tendon at its insertion point in the heel.
Due to the relationship of the its position on the back of the heel bone, the Achilles tendon has a direct effect on the plantar fascia, and has an opposing pull on it. At times, this opposing pull is the root cause of both plantar fasciitis and Achilles tendinitis, as they commonly exist concurrently in the same patient. There are also other versions of Achilles tendinitis that occur higher up on the tendon or where the tendon and muscle converge, but the insertional type at the heel bone are the most common.
How Are Plantar Fasciitis and Achilles Tendinitis Treated?
We have combined our collective experience and developed a systematic approach to heel pain. You will be introduced to the protocol on your first visit to our office.
Before beginning treatment, we may take x-rays or an ultrasound to assist in the diagnosis and rule out of any other possible causes of heel pain, such as a fracture or arthritis. Depending on your personal condition, duration or symptoms, and previous treatments, an individualized treatment protocol will be established. The vast majority of patients will find relief from plantar fasciitis through nonsurgical methods.
Nonsurgical Treatment of Plantar Fasciitis and Achilles Tendinitis
Non-surgical treatment begins with rest. Patients should reduce or even completely stop activities that make pain worse, including running or other activities that put extra stress on the feet. Rest will ease the pain and allow the tendons and ligaments to relax. Ice can help with pain and inflammation. Some patients find it helpful to roll the foot over a cold water bottle for 20 minutes at a time, three to four times a day. We may also recommend non-steroidal anti-inflammatory medications, like ibuprofen or naproxen, to help pain and swelling. Steroid injection therapy is also indicated when plantar fascia pain and inflammation is significant and impairs daily activity.
Since tight muscles in the calves and feet can agitate fasciitis and tendinitis, it may help to stretch out those muscles, especially before participating in exercise or any other physical activity. When appropriate, we may recommend physical therapy to assist with your heel pain protocol. We may recommend custom orthotics and properly fitted, supportive shoes to help cushion and support the heel as you walk. Night splints can also be effective for those who experience heel pain in the morning. Most people sleep with their feet pointed, which relaxes the plantar fascia. The splint stretches out the plantar fascia as you sleep, helping to relieve that morning tightness. We also offer platelet-rich plasma (PRP) injections as a treatment option, which harnesses your body’s own healing potential to help repair a diseased or injured tendon.
For those patients who do not respond to the protocol or have had previous failed treatment for heel pain, such as non-invasive extracorporeal shockwave therapy, surgery may be recommended.
Surgical Treatment of Plantar Fasciitis
For those patients who do not respond to an individualized protocol or have had previous failed treatment for heel pain, we use minimally invasive TENEX as a surgical option. Developed in conjunction with the Mayo Clinic, TENEX is a groundbreaking minimally invasive technology used to remove chronically diseased tendon and fascia, giving quick pain relief and early return to function.
If you have any questions about plantar fasciitis, Achilles tendinitis, or any other form of heel pain, please contact us at (212) 355-4229.
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