Plantar Fasciitis (Heel Pain)
Pain in the heel is one of the most common problems that a foot specialist treats. The actual cause of heel pain can be a difficult to diagnosis. Most often with conservative treatment, patients can be relieved of their symptoms. The development of heel pain can be a slow insidious process, and therefore, the recovery can take months as well. One of the most common causes of heel pain is from the pull on the heel exerted by the muscles and ligaments that support the arch of the foot. This condition is referred to as plantar fasciitis, and it is an inflammatory process similar to tennis elbow. Plantar Fasciitis pain is typically worse in the morning and with walking, but tends to get better throughout the day. Individuals with flat feet and a tight Achilles may be more frequently affected. Those who are overweight, run very long distances, or participate in high impact activities may also have a higher incidence of plantar fasciitis. A heel spur is seen on x-ray in only about half the cases of plantar fasciitis. It forms at the attachment of the muscles and ligaments to the heel bone. Heel spurs are not the primary cause of the pain, and can generally be ignored.
Plantar Fasciitis is generally a self-limited process but it can take a long time to resolve. The treatment can be tailored according to the duration of symptoms and the degree of pain. Conservative treatment is successful in nearly 90% of patients. Only rarely do plantar fasciitis patients require surgery. Anti-inflammatory medications, temporarily limited activities, and Achilles with plantar fascia stretching will usually relieve the condition. A night splint to keep the foot in a neutral position while you sleep has been shown to be very beneficial. High heels and restrictive footwear can exacerbate the condition so we highly recommend transitioning into a cushioned athletic shoe with a good off-the-shelf arch support. Sometimes custom foot orthotics can be beneficial if patients have no relief with an off-the-shelf arch support. Avoid walking barefoot as much as possible. If the problem persists despite trying these things, then the tender area can be injected with a steroid and local anesthetic. For safety after an injection, patients are often placed in a walking cast to protect the plantar fascia as injections have a small risk of rupturing the fascia.
Surgery can be done if other treatments fail. The aim of operative intervention is to release the tight fascia, relieve nerve pressure, or to do both. Surgery is generally effective but is only done after other treatment modalities have failed. The recovery process from plantar fascia release can take a few months. Much of the time immediately after surgery is spent resting and elevating your leg to decrease swelling. We generally recommend you keep your leg elevated as much as possible during the first week. You will be discharged from the hospital immediately after surgery with a prescription for pain medicine to help control your pain. Most patients are discharged home in a splint which will be converted to a cast in the office. Stitches are generally removed around 2–3 weeks. Patients are placed in a postoperative non-weight bearing cast for six weeks followed by a walking cast for another six weeks. You will not be able to put weight on your foot during the first six weeks and will need to use crutches, a walker, or a rolling knee walker to mobilize. Patients are generally transitioned from a cast into a regular shoe with an arch support at 12 weeks.
© 2015 Jesse F. Doty, MD - Reviewed: October, 2015
Dr. Doty is a foot and ankle fellowship-trained orthopaedic surgeon with an interest in providing musculoskeletal care to the lower extremity. Subspecialty training equips him to confidently address some of the most complicated deformities of the foot and ankle. He is well-versed in internal fixation as well as external fixation in treating chronic hindfoot and forefoot deformities.