Heel Pain
(Plantar Fasciitis)
Heel pain is very common. Plantar fasciitis is by far the most common cause of heel pain that we see as foot and ankle specialists. The good news is that we are quite good at treating it successfully. New onset heel pain typically peaks around the summer time, when patients begin walking barefoot or using less supportive footwear like flip flops or sandals.
The pain is usually caused by tightening of the plantar fascia ligament located on the bottom of the foot. The plantar fascia is a strong band of tissue that helps support your arch and absorbs shock when you walk. Patients will often complain of pain with the first step in the morning, tightness, and worsening pain by the end of the day.
Conservative measures consist of shoe gear modification, anti-inflammatories, orthotics, strapping, stretching exercises and night splints. Your surgeon will obtain X-Rays here in the office and may also evaluate your plantar fascia under Ultra Sound examination. When first line treatments don’t resolve the pain we can move on to corticosteroid injections, custom orthotics, and Physical Therapy.
Heel spurs are frequently seen together with plantar fasciitis. Contrary to popular belief a spur in the bottom aspect of the foot does not cause pain. The pain is generated from the plantar fascia and tissues surrounding the spur. Surgeons have known this now for some time therefore a “spur removal” is not performed anymore during plantar fascia surgery.
When to consider surgery?
Patients will undergo six to twelve months of conservative therapy before any surgery is considered. Only about 10% of patients will not respond well to conservative measures and may go on to require surgery. Other reasons for heel pain that can impersonate plantar fasciitis have to be ruled out prior to any surgical intervention. An MRI is always obtained as well.
Plantar fasciitis surgery consists of releasing the tight plantar fascia. This can be done in a minimally invasive manner or open approach. Your surgeon may or not need to also perform an Achilles tendon lengthening or calf muscle release. Post-operative protocol will highly depend on your surgeon’s preference and type of procedure(s) performed.