Heel pain is a common complaint heard by podiatrists. The leading source of such ailments is a condition known as plantar fasciitis. Perhaps surprisingly, research has found that one in 10 people – nearly 33 million Americans – will suffer from plantar fasciitis at some point in their lives.
A quick anatomy lesson: Plantar fascia is the thick connective tissue which supports the arch on the bottom (plantar side) of the foot. That tissue runs across the bottom of each foot and connects the heel bone to the toes.
As you might expect, the elasticity of the plantar fascia tends to deteriorate with age. Physical exercise like walking and running is of course a consistent recommendation for many people, but active adults aged 40 and older are at the highest risk of developing the condition. Also prone to plantar fasciitis are those who are significantly overweight, including pregnant women, who are putting more stress on their feet.
Typically those with plantar fasciitis experience sharp pain when first getting up in the morning, as well as standing after a long time sitting. The pain usually decreases after these occurrences, but there really is no need to continue suffering from the condition when a variety of treatments are available.
Some solutions are simple:
- Proper stretching before physical activity
- Icing the affected heel
- Taking over-the-counter pain medication
- Merely resting the foot
On the preventive side, always go with shoes that properly fit; if you have flat feet/fallen arches, be sure to wear shoes with supportive arches inside, which help with stability.
Should the above methods not provide sufficient relief, we might try an anti-inflammatory injection of a corticosteroid, often followed by physical therapy involving strengthening the patient’s lower leg muscles.
If we have still not achieved the desired results, surgery may be required. Relatively new is the Tenex procedure, a minimally invasive approach that received FDA approval in 2012. (The procedure is also used for treating chronic tendon pain.) This method uses high-frequency vibrations and ultrasound technology to remove the accumulated build-up of scar tissue and promote blood circulation and mobility to the area so that it can heal better; most patients fully recover in about 4-6 weeks.
On rare occasions, the worst-case scenario involves performing an endoscopic plantar fasciotomy (EPF). This involves making 1 or 2 incisions (less than ½ inch long) on each side of the heel or both on one side of the foot. Parts of the fascia near the heel bone are then cut and removed. Complications can be significant, and normal activity is usually not advised before 3 to 6 weeks.
There are of course several other causes of heel pain, including Achilles tendonitis, heel bursitis, bone spurs in the heel, and Sever’s disease, which is in some ways similar to plantar fasciitis but affects children, usually during growth spurts. Again, there are a number of mostly conservative approaches to treating those conditions.
Please note that research has also found that about four out of five cases of heel pain resolve themselves within a year. Waiting that long to see if it will heal itself may not be a very attractive option, however. If you are experiencing ongoing heel pain, see your primary care physician or a podiatrist as soon as you can.
Dr. Edward Costa is a board-certified podiatrist at the Scarsdale Medical Group office in Harrison and at the White Plains Hospital Physician Associates office in Larchmont. His specialties include orthotics. For an appointment, call 914-723-8100.