How is plantar fasciitis diagnosed. What are the most effective treatments for plantar fasciitis. Which home remedies can alleviate heel pain caused by plantar fasciitis. When should you seek medical attention for persistent heel pain.

Understanding Plantar Fasciitis: Causes and Symptoms

Plantar fasciitis is a common cause of heel pain that affects millions of people worldwide. This condition occurs when the plantar fascia, a thick band of tissue connecting the heel bone to the toes, becomes inflamed or irritated. The resulting pain can be debilitating, especially during the first steps in the morning or after prolonged periods of rest.

What causes plantar fasciitis? The condition often results from a combination of factors, including:

• Excessive stress on the plantar fascia
• Age-related wear and tear
• Improper footwear
• Obesity or sudden weight gain
• High-impact activities or sports
• Flat feet or high arches

Can plantar fasciitis develop suddenly? While the condition typically develops gradually, some individuals may experience a sudden onset of heel pain. This is often associated with a rapid increase in physical activity or a change in footwear.

Diagnosing Plantar Fasciitis: Medical Evaluation and Imaging Tests

Accurate diagnosis is crucial for effective treatment of plantar fasciitis. How do medical professionals diagnose this condition? The process typically involves a combination of medical history review and physical examination.

Medical History and Physical Examination

During the initial consultation, your doctor will inquire about your symptoms, their onset, and any factors that may exacerbate or alleviate the pain. The physical examination involves checking for areas of tenderness in your foot, particularly along the plantar fascia and around the heel bone.

Is pain location significant in diagnosing plantar fasciitis? Indeed, the location of your pain can provide valuable clues about its cause. Plantar fasciitis typically causes pain at the base of the heel or along the arch of the foot.

Imaging Tests: When Are They Necessary?

In most cases, plantar fasciitis can be diagnosed without the need for imaging tests. However, your doctor may recommend additional tests to rule out other potential causes of heel pain. These may include:

• X-rays: To check for bone spurs or stress fractures
• Magnetic Resonance Imaging (MRI): To visualize soft tissue structures and detect any abnormalities

Do bone spurs always indicate plantar fasciitis? Interestingly, while X-rays may reveal bone spurs on the heel, these are not always associated with heel pain. Many individuals with bone spurs experience no symptoms, highlighting the importance of a comprehensive evaluation.

Conservative Treatments for Plantar Fasciitis: Rest, Ice, and Stretching

For most individuals diagnosed with plantar fasciitis, conservative treatments prove effective in alleviating symptoms within several months. What are the primary conservative approaches to managing plantar fasciitis?

Rest and Ice Therapy

Resting the affected foot is crucial in allowing the inflamed plantar fascia to heal. Applying ice to the painful area can help reduce inflammation and provide relief. How often should you apply ice? Experts recommend icing the affected area for 15 minutes, three to four times daily.

Stretching Exercises

Gentle stretching exercises targeting the plantar fascia, Achilles tendon, and calf muscles can significantly improve flexibility and reduce pain. Which stretches are most effective for plantar fasciitis?

1. Plantar fascia stretch: Roll your foot over a tennis ball or frozen water bottle
2. Calf stretch: Lean against a wall with one leg extended behind you
3. Toe stretch: Gently pull your toes back towards your shin

How often should you perform these stretches? Aim to complete each stretch 3-5 times, holding for 20-30 seconds, and repeat 2-3 times daily for optimal results.

Medications and Therapies: Alleviating Pain and Promoting Healing

When conservative measures alone prove insufficient, various medications and therapies can provide additional relief and support healing. What are the most common pharmacological and therapeutic interventions for plantar fasciitis?

Pain Relievers and Anti-inflammatory Medications

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium can help manage pain and reduce inflammation associated with plantar fasciitis. Are these medications suitable for long-term use? While effective for short-term relief, prolonged use of NSAIDs should be discussed with a healthcare provider due to potential side effects.

Physical Therapy

A physical therapist can develop a customized treatment plan to address your specific needs. This may include:

• Targeted stretching and strengthening exercises
• Manual therapy techniques
• Instruction on proper athletic taping for foot support

How long does physical therapy typically last for plantar fasciitis? The duration varies depending on individual factors, but many patients see improvement within 6-8 weeks of consistent therapy.

Night Splints and Orthotics

Night splints maintain a gentle stretch of the plantar fascia and Achilles tendon during sleep, promoting flexibility and reducing morning pain. Custom or over-the-counter orthotics can provide additional arch support and help distribute pressure more evenly across the foot.

Are custom orthotics always necessary? While some individuals benefit from custom-made orthotics, many find relief with high-quality over-the-counter inserts designed for plantar fasciitis.

Advanced Treatments: When Conservative Approaches Fall Short

For cases of plantar fasciitis that do not respond to conservative treatments after several months, more advanced interventions may be considered. What are the options for persistent plantar fasciitis?

Corticosteroid Injections

Injecting a corticosteroid medication into the affected area can provide temporary pain relief. However, multiple injections are generally not recommended due to the risk of weakening the plantar fascia.

Platelet-Rich Plasma (PRP) Injections

This innovative treatment uses the patient’s own blood components to promote tissue healing. How effective is PRP for plantar fasciitis? While research is ongoing, some studies have shown promising results in reducing pain and improving function.

Extracorporeal Shock Wave Therapy (ESWT)

ESWT uses sound waves directed at the area of heel pain to stimulate healing. Although not consistently effective for all patients, it may be considered for chronic cases that have not responded to other treatments.

Ultrasonic Tissue Repair

This minimally invasive procedure uses ultrasound imaging to guide a probe that breaks up damaged tissue, which is then removed. How does ultrasonic tissue repair compare to traditional surgery? It offers the potential for faster recovery and reduced risk of complications compared to open surgery.

Surgical Intervention

In rare cases where all other treatments have failed, surgery to detach the plantar fascia from the heel bone may be considered. This can be performed as an open procedure or through a small incision under local anesthesia.

Lifestyle Modifications and Home Remedies for Plantar Fasciitis

Incorporating lifestyle changes and home remedies can significantly contribute to managing plantar fasciitis and preventing its recurrence. What are the most effective self-care strategies for heel pain relief?

Maintaining a Healthy Weight

Excess body weight places additional stress on the plantar fascia. How much can weight loss impact plantar fasciitis symptoms? Even modest weight loss can lead to significant reduction in heel pain and improved foot function.

Choosing Appropriate Footwear

Selecting shoes with proper support is crucial in managing plantar fasciitis. What features should you look for in supportive shoes?

• Low to moderate heel
• Thick, cushioned soles
• Good arch support
• Ample toe room

Is it advisable to walk barefoot with plantar fasciitis? Walking barefoot, especially on hard surfaces, can exacerbate symptoms. It’s best to wear supportive shoes or slippers, even indoors.

Modifying Activities

Temporarily switching to low-impact activities can help reduce stress on the plantar fascia. Which activities are best for individuals with plantar fasciitis?

• Swimming
• Cycling
• Yoga (with modifications)
• Strength training (focusing on upper body and core)

Regular Stretching and Strengthening

Incorporating daily stretching and strengthening exercises can improve flexibility and support the arch of the foot. How can you make stretching a consistent habit? Try integrating stretches into your daily routine, such as while brushing your teeth or watching television.

When to Seek Medical Attention: Red Flags and Persistent Symptoms

While many cases of plantar fasciitis respond well to conservative treatments and home remedies, certain situations warrant professional medical evaluation. When should you consult a healthcare provider for heel pain?

Persistent or Worsening Pain

If heel pain persists or intensifies despite several weeks of home treatment, it’s advisable to seek medical attention. How long should you try self-care before consulting a doctor? Generally, if symptoms haven’t improved after 2-3 weeks of consistent home treatment, it’s time to seek professional advice.

Sudden, Severe Pain

Abrupt onset of severe heel pain, especially following an injury, may indicate a more serious condition such as a fracture or tendon rupture. These situations require immediate medical evaluation.

Accompanying Symptoms

Certain symptoms accompanying heel pain may suggest other underlying conditions. What additional symptoms should prompt medical consultation?

• Fever
• Redness or warmth in the heel area
• Numbness or tingling in the foot
• Pain that extends up the leg

Impact on Daily Activities

When heel pain significantly interferes with your ability to perform daily activities or affects your quality of life, it’s important to seek professional help. A healthcare provider can offer additional treatment options and help develop a comprehensive management plan.

By understanding the causes, diagnostic process, and various treatment options for plantar fasciitis, individuals can take proactive steps to manage their symptoms effectively. Remember that early intervention and consistent adherence to treatment plans often lead to the best outcomes. If you’re experiencing persistent heel pain, don’t hesitate to consult with a healthcare professional to receive personalized advice and care.

Plantar fasciitis – Diagnosis and treatment

Diagnosis

Plantar fasciitis is diagnosed based on your medical history and physical examination. During the exam, your doctor will check for areas of tenderness in your foot. The location of your pain can help determine its cause.

Imaging tests

Usually no tests are necessary. Your doctor might suggest an X-ray or magnetic resonance imaging (MRI) to make sure another problem, such as a stress fracture, is not causing you pain.

Sometimes an X-ray shows a piece of bone sticking out (spur) from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain.

Treatment

Most people who have plantar fasciitis recover in several months with conservative treatment, including resting, icing the painful area and stretching.

Medications

Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) may ease the pain and inflammation caused by plantar fasciitis.

Therapies

Stretching and strengthening exercises or using special devices may relieve symptoms. They include:

• Physical therapy. A physical therapist can show you a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles. A therapist might also teach you to apply athletic taping to support the bottom of your foot.
• Night splints. Your physical therapist or doctor might recommend that you wear a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight to promote stretching.
• Orthotics. Your doctor might prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.

Surgical or other procedures

If more-conservative measures aren’t working after several months, your doctor might recommend:

• Injections. Injecting steroid medication into the tender area can provide temporary pain relief. Multiple shots aren’t recommended because they can weaken your plantar fascia and possibly cause it to rupture. Using ultrasound imaging, platelet-rich plasma obtained from the patient’s own blood can be injected to promote tissue healing.
• Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It’s usually used for chronic plantar fasciitis that hasn’t responded to more-conservative treatments. Some studies show promising results, but it hasn’t been shown to be consistently effective.
• Ultrasonic tissue repair. This minimally invasive technology was developed in part by Mayo Clinic doctors. It uses ultrasound imaging to guide a needlelike probe into the damaged plantar fascia tissue. Using ultrasound energy, the probe tip vibrates rapidly to break up the damaged tissue, which is then suctioned out.
• Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It is generally an option only when the pain is severe and other treatments have failed. It can be done as an open procedure or through a small incision with local anesthesia.

Lifestyle and home remedies

To reduce the pain of plantar fasciitis, try these self-care tips:

• Maintain a healthy weight. Carrying extra weight can put extra stress on your plantar fascia.
• Choose supportive shoes. Buy shoes with a low to moderate heel, thick soles, good arch support and extra cushioning. Don’t walk barefoot.
• Don’t wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet.
• Change your sport. Try a low-impact sport, such as swimming or bicycling, instead of walking or jogging.
• Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 minutes three or four times a day. Icing can help reduce pain and inflammation.
• Stretch your arches. Simple home exercises can stretch your plantar fascia, Achilles tendon and calf muscles.

Preparing for your appointment

While you may initially consult your family physician, he or she may refer you to a doctor who specializes in foot disorders or sports medicine.

What you can do

You may want to write a list that includes:

• Your symptoms, and when they started
• Key personal information, including your and your family’s medical history and activities you do that could have contributed to your symptoms
• All the medications, vitamins or other supplements you take, including doses
• Questions to ask the doctor

For plantar fasciitis, basic questions to ask your doctor include:

• What’s likely causing my symptoms?
• Other than the most likely cause, what are other possible causes for my symptoms?
• What tests do I need?
• Is my condition likely temporary or chronic?
• What’s the best course of action?
• What are the alternatives to the primary approach you’re suggesting?
• Are there restrictions I need to follow?
• Should I see a specialist?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don’t hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

• Do your symptoms tend to occur at a particular time of day?
• What types of shoes do you usually wear?
• Are you a runner, or do you participate in any sports that involve running?
• Do you have a physically demanding job?
• Have you had problems with your feet before?
• Do you feel pain anywhere besides your feet?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

Dec. 11, 2019

Heel and Foot Pain (Plantar Fasciitis)

Some anatomy of your foot

Spare a thought for your feet – they have to bear the weight of your whole body. There are many bones in each foot (see the images below) and these can briefly be divided into three parts:

• Forefoot: made up of the toes (phalanges) and the five long bones (metatarsals). These are named from first to fifth. The first metatarsal bone is the largest and is the bone that joins to your big toe. Each toe has three phalanges, except the big toe which has only two. This means there are three joints in the toes (two in the big toe).
• Midfoot: a collection of bones forming the arches of the foot.
• Hindfoot: the ankle joint and the tarsal bones, including the biggest, the heel bone (calcaneum).

What is the Achilles tendon?

Your Achilles tendon is an important part of your leg. It is found just behind and above your heel. It joins your heel bone (calcaneum) to your calf muscles. The function of your Achilles tendon is to help in bending your foot downwards at the ankle, as iyou do when you’re pointing your toes. (This movement is called plantar flexion.)

What is the plantar fascia?

Your plantar fascia is a strong band of tissue (like a ligament) that stretches from your heel (calcaneum) to your middle foot bones. It supports the arch of your foot and also acts as a shock absorber in your foot.

There are also many other tendons, as well as muscles and ligaments, within your foot. The bones, ligaments and tendons within your foot form the foot arches. These arches are called the longitudinal and transverse arches. It is your foot arches that allow your foot to hold up the weight of your body. Nerves provide sensation to the skin of your foot.

What causes foot pain?

Dr Sarah Jarvis MBE

What causes heel and foot pain?

Do you have painful feet? You’re not alone – plantar fasciitis is a really common cause of pain under the heel (calcaneum). While plantar fasciitis is one of the most common causes of heel and foot pain, it is not the only reason:

Common causes of heel and foot pain

• Plantar fasciitis (see below).
• Inflammation of the Achilles tendon (Achilles tendinopathy) can cause pain in the back of the ankle, going down to the back of the heel.
• Rupture of the Achilles tendon can cause sudden heel pain and problems walking.
• In the ball of your foot:
• Flat feet by contrast can cause pain almost anywhere in the foot, although usually the condition doesn’t cause any symptoms.
• Sever’s disease is a painful inflammation of the heel that can affect children between the ages of 8 and 14 years.

There are also many conditions that can cause problems elsewhere in the body, as well as in the feet – for example:

• Conditions that cause painful joints, such as:
• Gout often causes sudden severe pain in the foot, typically the big toe.
• Bunions (hallux valgus) also cause pain in the big toe but this comes on very gradually.
• Problems with the nerves to the feet, such as peripheral neuropathy, sciatica or tarsal tunnel syndrome.
• Problems with the blood vessels to the feet, which is usually due to peripheral arterial disease or diabetes.

Flat feet can cause pain anywhere in the foot

The rest of this leaflet is about plantar fasciitis.

What is plantar fasciitis?

What is heel pain?

Dr Sarah Jarvis MBE

Plantar fasciitis means inflammation of your plantar fascia. 

It is a condition that affects around one in ten people at some point in their lives. It’s also known as ‘jogger’s heel’ – although you don’t have to be a runner to develop it. Luckily, it usually gets better in time, but treatment may speed up your recovery. So, what can you do about it? Useful treatment includes rest, good footwear, heel pads, painkillers and exercises. A steroid injection or other treatments may be used in more severe cases.

What causes it?

Repeated small injuries to the fascia (with or without inflammation) are thought to be the cause of plantar fasciitis. The injury is usually near to where the plantar fascia attaches to your heel bone.

What makes it likely for someone to develop plantar fasciitis?

You are more likely to injure your plantar fascia in certain situations. For example:

• If you are on your feet for a lot of the time, or if you do lots of walking, running, standing, etc, when you are not used to it or have previously had a more sedentary lifestyle.
• If you have recently started exercising on a different surface – for example, running on the road instead of a track.
• If you have been wearing shoes with poor cushioning or poor arch support.
• If you are overweight – this will put extra strain on your heel.
• If there is overuse or sudden stretching of your sole. For example – athletes who increase running intensity or distance; poor technique starting ‘off the blocks’, etc.
• If you have a tight Achilles tendon (the big tendon at the bottom of your calf muscles above your heel). This can affect your ability to flex your ankle and may make you more likely to damage your plantar fascia.

Plantar fasciitis may be confused with ‘policeman’s heel’ but they are different. Policeman’s heel is called plantar calcaneal bursitis – inflammation of the sack of fluid (bursa) under the heel bone (calcaneum). This is not as common as plantar fasciitis.

Often there is no apparent cause for plantar fasciitis, particularly in older people. A common wrong belief is that the pain is due to a bony growth, or ‘spur’, coming from the heel bone. Many people have a bony spur of the heel bone but not everyone with this develops plantar fasciitis.

How common is it?

Plantar fasciitis is common. Around 1 in 10 people will develop plantar fasciitis at some time in their lives. It is most common in people between the ages of 40 to 60 years. However, it can occur at any age. It is twice as common in women as it is in men. It is also common in athletes.

What are the symptoms?

Pain is the main symptom and this can be anywhere on the underside of your heel. However, commonly, one particular area is found as the main source of pain. 

Where is the plantar fascia?

This diagram shows the position of the plantar fascia in relation to the bones in the foot. Inflammation of this band of tissue causes the symptoms of plantar fasciitis. (‘-itis’ is the medical term for inflammation).

What symptoms does inflammation of the plantar fascia cause?

Pain is the main symptom. You can imagine how the inflamed plantar fascia can hurt when you put pressure on the foot while walking. This pain can be anywhere on the underside of your heel. However, commonly, one spot is found as the main source of pain. This is often about 4 cm forward from your heel and may be tender to touch.

The pain is often worst when you take your first steps on getting up in the morning, or after long periods of rest where no weight is placed on your foot. Often, it’s described as a stabbing or aching pain. Gentle exercise may ease things a little as the day goes by. However, a long walk or being on your feet for a long time often makes the pain worse. Resting your foot usually eases the pain – this can be very frustrating for people who are trying to improve their fitness levels by taking up running!

Sudden stretching of the sole of your foot may make the pain worse – for example, walking up stairs or on tiptoes. You may limp because of pain. Some people have plantar fasciitis in both feet at the same time.

How is it diagnosed?

Your doctor can usually diagnose plantar fasciitis just by talking to you and examining your feet. Rarely, tests are needed if the diagnosis is uncertain or to rule out other possible causes of heel pain. These can include X-rays of the heel or an ultrasound scan of the fascia. An ultrasound scan usually shows thickening and swelling of the fascia in plantar fasciitis.

What is the treatment?

Usually, the pain will ease in time. ‘Fascia’ tissue, like ‘ligament’ tissue, heals quite slowly. It may take several months or more to go. However, there is a variety of treatments that may help to speed recovery. A combination of different treatments may help. These vary from rest and simple exercises (most common) to surgery (rare).

Collectively, these initial treatments are known as ‘conservative’ treatments for plantar fasciitis:

Rest your foot

This should be done as much as possible. Avoid running, excess walking or standing, and undue stretching of your sole. Gentle walking and exercises described below are fine.

Footwear

Do not walk barefoot on hard surfaces. Choose shoes with cushioned heels and a good arch support. A laced sports shoe rather than an open sandal is probably best. Avoid old or worn shoes that may not give a good cushion to your heel.

Heel pads and arch supports

You can buy various pads and shoe inserts to cushion the heel and support the arch of your foot. These work best if you put them in your shoes at all times. The aim is to raise your heel by about 1 cm. If your heel is tender, cut a small hole in the heel pad at the site of the tender spot. This means that the tender part of your heel will not touch anything inside your shoe. Place the inserts/pads in both shoes, even if you only have pain in one foot. A podiatrist may be able to help with specialist inserts.

Pain relief

Painkillers such as paracetamol will often ease the pain. Sometimes anti-inflammatory medicines such as ibuprofen are useful. These are painkillers but also reduce inflammation and may work better than ordinary painkillers. Some people find that rubbing a cream or gel that contains an anti-inflammatory medicine on to their heel is helpful.

An ice pack (such as a bag of frozen peas wrapped in a tea towel) held to your foot for 15-20 minutes may also help to relieve pain.

Exercises

Regular, gentle stretching of your Achilles tendon and plantar fascia may help to ease your symptoms. This is because most people with plantar fasciitis have a slight tightness of their Achilles tendon. If this is the case, it tends to pull at the back of your heel and has a knock-on effect of keeping your plantar fascia tight. Also, when you are asleep overnight, your plantar fascia tends to tighten up (which is why it is usually most painful first thing in the morning). The aim of these exercises is to loosen up the tendons and fascia gently above and below your heel. Your doctor may refer you to a physiotherapist for exercise guidance.

Watch our physiotherapist taking you through all the exercises for plantar fasciitis in our video.

Exercises (done with or without shoes on) to help treat plantar fasciitis

Choosing the correct footwear can help to reduce pain

• Stand about 40 cm away from a wall and put both hands on the wall at shoulder height, feet slightly apart, with one foot in front of the other. Bend your front knee but keep your back knee straight and lean in towards the wall to stretch. You should feel your calf muscle tighten. Keep this position for several seconds, then relax. Do this about 10 times then switch to the other leg. Now repeat the same exercise for both legs but this time, bring your back foot forward slightly so that your back knee is also slightly bent. Lean against the wall as before, keep the position, relax and then repeat 10 times before switching to the other leg. Repeat this routine twice a day.
• Stand on the bottom step of some stairs with your legs slightly apart and with your heels just off the end of the step. Hold the stair rails for support. Lower your heels, keeping your knees straight. Again you should feel the stretch in your calves. Keep the position for 20-60 seconds, then relax. Repeat six times. Try to do this exercise twice a day.
• Sit on the floor with your legs out in front of you. Loop a towel around the ball of one of your feet. With your knee straight, pull your toes towards your nose. Hold the position for 30 seconds and repeat three times. Repeat the same exercise for the other foot. Try to do this once a day.
• Sit on a chair with your knees bent at right angles and your feet and heels flat on the floor. Lift your foot upwards, keeping your heel on the floor. Hold the position for a few seconds and then relax. Repeat about 10 times. Try to do this exercise five to six times a day.
• For this exercise you need an object such as a rolling pin or a drinks can. Whilst sitting in a chair, put the object under the arch of your foot. Roll the arch of your foot over the object in different directions. Perform this exercise for a few minutes for each foot at least twice a day. This exercise is best done without shoes on.

Plantar Fasciitis Management Options

Each treatment option for Plantar Fasciitis has various benefits, risks and consequences. In collaboration with health.org.uk, we’ve put together a summary decision aid that encourages patients and doctors to discuss and assess what’s available.

Are there any other treatments?

If the above treatments are not helping to relieve your symptoms, or if you are someone such as an athlete who needs a quick recovery, other treatments are available. There is no one specific treatment that appears to stand out as the best.

Steroid injections

A steroid (cortisone) injection is sometimes tried if your pain remains bad despite the above ‘conservative’ measures. It may relieve the pain in some people for several weeks but does not always cure the problem. It is not always successful and may be sore to have done. Steroids work by reducing inflammation. Sometimes two or three injections are tried over a period of weeks if the first is not successful. Steroid injections do carry some risks, including (rarely) tearing (rupture) of the plantar fascia.

Extracorporeal shock-wave therapy

In extracorporeal shock-wave therapy, a machine is used to deliver high-energy sound waves through your skin to the painful area on your foot. It is not known exactly how it works but it is thought that it might stimulate healing of your plantar fascia. One or more sessions of treatment may be needed.

This procedure appears to be safe but it is uncertain how well it works. This is mostly because of a lack of large, well-designed clinical trials. You should have a full discussion with your doctor about the potential benefits and risks.

In studies, most people who have had extracorporeal shock-wave therapy have little in the way of problems. However, possible problems that can occur include pain during treatment, skin reddening, and swelling of your foot or bruising. Another theoretical problem could include the condition becoming worse because of rupture of your plantar fascia or damage to the tissues in your foot. More research into extracorporeal shock-wave therapy for plantar fasciitis is needed.

Other possible treatments

Various studies and trials have been carried out looking at other possible treatments for plantar fasciitis. Such treatments include injection with botulinum toxin and treatment of the plantar fascia with radiotherapy. These treatments may not be widely available.

Some people benefit from wearing a special splint overnight to keep their Achilles tendon and plantar fascia slightly stretched. The aim is to prevent the plantar fascia from tightening up overnight. In very difficult cases, sometimes a plaster cast or a removable walking brace is put on the lower leg. This provides rest, protection, cushioning and slight stretching of the plantar fascia and Achilles tendon. However, the evidence for the use of splint treatment of plantar fasciitis is limited.

What about surgery?

This may be considered in very difficult cases. Surgery is usually only advised if your pain has not eased after 12 months despite other treatments. The operation involves separating your plantar fascia from where it connects to the bone; this is called a plantar fascia release. It may also involve removal of a spur on the heel bone (calcaneum) if one is present. Surgery is not always successful. It can cause complications in some people so it should be considered as a last resort. Complications may include infection, increased pain, injury to nearby nerves, or rupture of the plantar fascia.

What is the outlook (prognosis)?

Most people have completely recovered from an episode of plantar fasciitis within a year. However, some of the treatments described above may help to speed up your recovery.

Can it be prevented?

There are certain things that you can do to try to prevent plantar fasciitis, especially if you have had it before. These include:

• Regularly changing training shoes used for running or walking.
• Wearing shoes with good cushioning in the heels and good arch support.
• Losing weight if you are overweight.
• Regularly stretching the plantar fascia and Achilles tendon, especially before exercise.
• Avoiding exercising on hard surfaces.

Health Tips | Six Exercises for Plantar Fasciitis and Heel Pain

Plantar fasciitis is a condition that causes heel pain. It can affect people of all ages and abilities, but is more common among runners and people who spend a lot of time on their feet.

Research shows that both strengthening and stretching exercise programs, including stretching the Achilles tendon, can significantly reduce pain and improve walking in people with plantar fasciitis.

If you’ve been diagnosed with plantar fasciitis or have heel pain, a physical therapist can design a treatment program for you. Treatment can include:

• Assessing how you walk and gait training.
• Instruction for when to apply ice for pain and inflammation.
• Temporary taping of your foot for short-term relief.
• Recommending shoe inserts, supportive footwear, or a night splint.
• Teaching you specific stretching and strengthening exercises.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.

Find a PT Near You!

Here are six exercises from physical therapists that you can try at home.

1. Plantar Fascia Massage

Note: You should not experience pain during this exercise. Apply enough pressure to feel a gentle stretch, but not pain.

• Sit in a chair or stand with one foot resting on a small ball or frozen water bottle. A frozen water bottle is useful as the ice helps reduce inflammation.
• Gently roll the ball or water bottle forward and backward under your foot. Start at just below the ball of your foot and end just before your heel.
• Roll the ball or bottle back and forth slowly 10 times for each foot. Do two sets per foot.
• Do this exercise once daily.

2. Heel Raise

Note: This exercise should be done slowly and with controlled movements. Make sure to maintain your balance and hold on to a railing or other support if needed.

• Stand with the balls of your feet at the edge of a bottom step.
• With your heels hanging off the edge, slowly and gently lower your heels just below the edge of the step. You may feel a stretch in your calf muscle.
• Slowly rise onto the balls of your feet.
• Repeat this 10 times, then rest. Complete two sets of this exercise.
• Do this exercise once daily.

3. Floor Sitting Ankle Inversion With Resistance

Note: This exercise requires an elastic exercise band.

• Sit upright on the floor with your legs straight out in front of you. Make sure to avoid any hip movement while doing this exercise.
• Place your left leg over your right leg with a resistance band secured around your upper foot and looped around the bottom of your lower foot. Hold the end of the band in your hand.
• Slowly move your upper foot (the one with the resistance band around it) away from the lower foot. To do this, rotate your ankle inward and slowly return it to the starting position.
• Repeat 10 times and complete two sets per foot.
• Do this exercise once daily.

4. Seated Toe Towel Scrunches

Note: Make sure that your whole foot stays on the ground and that only your toes do the work of this exercise.

• Sit upright in a chair with one foot resting on a towel and spread your toes.
• Curl your toes to scrunch and draw the towel toward you 10 times. Do two sets per foot.
• Do this exercise once daily.

5. Seated Plantar Fascia Stretch

Note: Complete this stretch in a slow and controlled manner.

• Sit in a chair and cross one leg over the other knee, so your ankle is on top of your other leg.
• With one hand holding your ankle and the other holding your toes, gently pull your toes backward until you feel a stretch in the bottom of your foot.
• Hold this position for 20 seconds and repeat three times for both feet.
• Do this exercise once daily.

6. Wall-Facing Calf Stretch

• Stand upright facing a wall at arm’s length and place your hands flat on the wall.
• Keeping both feet flat on the floor, extend one leg straight backward, bending your front leg until you feel a stretch in the calf of your back leg.
• Hold for 20 seconds and repeat three times for both legs.
• Do this exercise once daily.

Additional Resources

Plantar Fasciitis | Michigan Medicine

Topic Overview

What is plantar fasciitis?

Plantar fasciitis (say “PLAN-ter fash-ee-EYE-tus”) is the most common cause of heel pain. The plantar fascia is the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk.

Plantar fasciitis is common in middle-aged people. It also occurs in younger people who are on their feet a lot, like athletes or soldiers. It can happen in one foot or both feet.

What causes plantar fasciitis?

Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen if:

• Your feet roll inward too much when you walk (excessive pronation).
• You have high arches or flat feet.
• You walk, stand, or run for long periods of time, especially on hard surfaces.
• You are overweight.
• You wear shoes that don’t fit well or are worn out.
• You have tight Achilles tendons or calf muscles.

What are the symptoms?

Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time.

If you have foot pain at night, you may have a different problem, such as arthritis, or a nerve problem such as tarsal tunnel syndrome.

How is plantar fasciitis diagnosed?

Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about:

• Your past health, including what illnesses or injuries you have had.
• Your symptoms, such as where the pain is and what time of day your foot hurts most.
• How active you are and what types of physical activity you do.

Your doctor may take an X-ray of your foot if he or she suspects a problem with the bones of your foot, such as a stress fracture.

How is it treated?

No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your foot get better:

• Give your feet a rest. Cut back on activities that make your foot hurt. Try not to walk or run on hard surfaces.
• To reduce pain and swelling, try putting ice on your heel. Or take an over-the-counter pain reliever like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve).
• Do toe stretches, calf stretches and towel stretches several times a day, especially when you first get up in the morning. (For towel stretches, you pull on both ends of a rolled towel that you place under the ball of your foot.)
• Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or try heel cups or shoe inserts (orthotics). Use them in both shoes, even if only one foot hurts.

If these treatments do not help, your doctor may recommend splints that you wear at night, shots of medicine (such as a steroid) in your heel, or other treatments. You probably will not need surgery. Doctors only suggest it for people who still have pain after trying other treatments for 6 to 12 months.

How long will it take for the pain to go away?

Plantar fasciitis most often occurs because of injuries that have happened over time. With treatment, you will have less pain within a few weeks. But it may take time for the pain to go away completely. It may take a few months to a year.

Stay with your treatment. If you don’t, you may have constant pain when you stand or walk. The sooner you start treatment, the sooner your feet will stop hurting.

Cause

Exactly what causes plantar fasciitis is not well understood. But it probably develops as the result of repeated small tears in the plantar fascia. Normally when you walk, your plantar fascia stretches as your foot strikes the ground. If the plantar fascia is strained by the way you walk or by repeated stress, it can become weak, swollen, and irritated (inflamed), and it can hurt when you stand or walk.

Conditions or activities that may lead to plantar fasciitis include:

• Things that affect how the feet work (biomechanical factors). These include abnormal inward twisting or rolling of the foot (pronation), high arches, flat feet, tight calf muscles, or tight tendons at the back of the heel (Achilles tendons).
• Repetitive activities, such as jobs that require prolonged walking or standing on hard or irregular surfaces or sports such as running.
• Things that put extra stress on the feet, such as being overweight or wearing shoes that are poorly cushioned, don’t fit well, or are worn out.
• The natural process of aging. Plantar fasciitis is most common in middle-aged adults.
• In rare cases, a single injury to the foot.

Symptoms

The classic symptom of plantar fasciitis is heel pain when you take your first steps after getting out of bed or after sitting for a long period of time. You may also have:

• Stiffness and pain in the morning or after resting that gets better after a few steps but gets worse as the day progresses.
• Pain that gets worse when you climb stairs or stand on your toes.
• Pain after you stand for long periods.
• Pain at the beginning of exercise that gets better or goes away as exercise continues but returns when exercise is completed.

Plantar fasciitis may be mistaken for other conditions with similar symptoms, such as arthritis or a nerve problem such as tarsal tunnel syndrome.

What Happens

Plantar fasciitis usually develops gradually. You may have heel pain only when you take your first steps after getting out of bed or after sitting for a long period of time. If you do not rest your feet, the pain will get worse. Other things, such as the repetitive stress of walking, standing, running, or jumping, will add to the injury, inflammation, and pain. The injured ligament may never heal completely if you are not able to stop the activity or change the condition that caused it.

As plantar fasciitis progresses:

• The heel pain gradually gets worse.
• You may change the way you walk to relieve the pain. This eventually may lead to more discomfort and pain and other problems with your foot, leg, hip, or back. Daily activities or sports may become even more limited.
• You eventually may have pain with any weight-bearing activity. Running and jumping may no longer be possible.
• A heel spur may form as a result of continued stress as the plantar fascia pulls on the heel bone. (By itself, a heel spur does not cause plantar fasciitis and does not usually cause problems. And you can have plantar fasciitis and not have a heel spur.)

If the condition is not treated, plantar fasciitis can cause constant heel pain when you stand or walk.

What Increases Your Risk

You have a greater chance of developing plantar fasciitis if you:

• Are middle-aged or older.
• Walk with an inward twist or roll of the foot (pronation) or have high arches or flat feet.
• Are overweight or suddenly gain a lot of weight.
• Have tight Achilles tendons (which attach the calf muscles to the heel bones) or tight calf muscles.
• Have habits or do activities that increase the stress on your feet, such as:
  • Wearing shoes with poor cushioning.
  • Walking or running without being conditioned for these activities.
  • Changing your walking or running surface (for example, from grass to concrete).
  • Having a job that involves prolonged standing on hard surfaces.
• Are an athlete or a member of the military. Some athletes, especially runners, are more likely to get plantar fasciitis because of:
  • Things that affect the way their feet strike the ground, such as not having enough flexibility in the foot and ankle or having stronger muscles in one leg than in the other.
  • The repetitive nature of sports activities.
  • Improper training.

If you are a runner, you increase your chance of developing plantar fasciitis if you:

• Abruptly change how hard or how long you run.
• Run on steep hills.
• Wear running shoes that do not have a cushioned sole, lack good arch support, or are worn out.

When should you call your doctor?

If you think you might have plantar fasciitis, call your doctor. The earlier a doctor diagnoses and treats your problem, the sooner you will have relief from pain.

Call your doctor immediately if you have heel pain with fever, with redness or warmth in your heel, or with numbness or tingling in your heel.

Call your doctor if you have:

• Pain that continues when you are not standing or bearing any weight on your heel.
• A heel injury that results in pain when you put weight on your heel.
• Heel pain that does not getter better after a week, even though you have tried rest, ice, over-the-counter pain medicine (such as ibuprofen or acetaminophen), and other home treatment.

Call your doctor if you have been diagnosed with plantar fasciitis and the home treatment you agreed on is not helping to control your heel pain.

Watchful waiting

If you have heel pain:

• First, try resting and icing your heel. If possible, stop or reduce activities that cause the pain, such as running, standing for long periods of time, or walking on hard surfaces.
• Try different shoes. Make sure they have good arch support and well-cushioned soles. Or if your current shoes are in good shape, try heel cups or shoe inserts (orthotics) to cushion your heel.
• Switch to other activities or exercises that don’t put pressure on your heel. After your symptoms are completely gone, gradually resume the activity that was causing pain.
• If you are an athlete, do not ignore or attempt to “run through” the pain. This can lead to a chronic problem that is more difficult to treat successfully.

Who to see

The following health professionals can evaluate and diagnose plantar fasciitis and recommend nonsurgical treatment:

If nonsurgical treatments fail to relieve your pain, your doctor may refer you to a specialist such as an orthopedist or podiatrist. If you are an athlete, your doctor may refer you to a sports medicine specialist to look for problems with how your feet strike the ground, how your feet are shaped, or your training routine.

The following health professionals can do surgery:

• Podiatric surgeon
• Orthopedic surgeon, especially one who specializes in foot and ankle conditions
• Sports medicine surgeon

Exams and Tests

To diagnose plantar fasciitis, your doctor will ask questions about your symptoms and your past health. He or she will also do a physical exam of your feet that includes watching you stand and walk.

X-rays aren’t helpful in diagnosing plantar fasciitis, because they do not show ligaments clearly. But your doctor might take X-rays if he or she suspects a stress fracture, bone cyst, or other foot or ankle bone problems. X-rays may show whether a heel spur is present, but a bone spur does not necessarily mean that a person has plantar fasciitis.

If the diagnosis is not clear, you may have other tests. Tests that are done in rare cases include ultrasound, MRI, blood tests, bone scans, and vascular testing, which can evaluate blood flow in the foot and lower leg. If your doctor suspects nerve entrapment, you may have neurological testing.

Treatment Overview

The goals of treatment for plantar fasciitis are to:

• Relieve inflammation and pain in the heel.
• Allow small tears in the plantar fascia ligament to heal.
• Improve strength and flexibility and correct foot problems such as excessive pronation so that you don’t stress the plantar fascia ligament.
• Allow you to go back to your normal activities.

Most people recover completely within a year. Out of 100 people with plantar fasciitis, about 95 are able to relieve their heel pain with nonsurgical treatments. Only about 5 out of 100 need surgery.^{footnote 1}

Treatment that you start when you first notice symptoms is more successful and takes less time than treatment that is delayed.

Initial treatment

There are many methods you can try to relieve the heel pain of plantar fasciitis. Even though their effectiveness has not been proved in scientific studies, these methods, used alone or in combination, work for most people.^{footnote 2}

• Rest your feet. Limit or, if possible, stop daily activities that are causing your heel pain. Try to avoid running or walking on hard surfaces, such as concrete.
• To reduce inflammation and relieve pain, put ice on your heel. You can also try a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil or Motrin, for example) or naproxen (Aleve, for example). NSAIDs come in pills and in a cream that you rub over the sore area.
• Wear shoes with good shock absorption and the right arch support for your foot. Athletic shoes or shoes with a well-cushioned sole are usually good choices.
• Try heel cups or shoe inserts (orthotics) to help cushion your heel. You can buy these at many athletic shoe stores and drugstores. Use them in both shoes, even if only one foot hurts.
• Put on your shoes as soon as you get out of bed. Going barefoot or wearing slippers may make your pain worse.
• Do simple exercises such as toe stretches, calf stretches, and towel stretches several times a day, especially when you first get up in the morning. These can help your ligament become more flexible and strengthen the muscles that support your arch. (For towel stretches, you pull on both ends of a rolled towel that you place under the ball of your foot.)

Avoid using only heat on your foot, such as from a heating pad or a heat pack for at least the first 2 or 3 days. Heat tends to make symptoms worse for some people. If you use contrast baths, which alternate hot and cold water, make sure you end with a soak in cold water. If you try a heating pad, use a low setting.

If your weight is putting extra stress on your feet, your doctor may encourage you to try a weight-loss program.

Ongoing treatment

If nonsurgical methods such as rest, ice, and stretching exercises help relieve your plantar fasciitis symptoms, continue using them. If you have not improved after 6 weeks, your doctor may recommend that you continue those methods but add other nonsurgical treatments, such as:

• Custom-made shoe inserts (orthotics). Custom-made orthotics require a prescription. If your foot has an unusual shape or if you have a certain problem that the device will help, then a custom-made insert may fit better and control pain better than a nonprescription one.
• Night splints. A night splint holds the foot with the toes pointed up and with the foot and ankle at a 90-degree angle. This position applies a constant, gentle stretch to the plantar fascia.
• A walking cast on the lower leg. Casting is somewhat more expensive and inconvenient than other nonsurgical treatments. And after the cast is removed, you will need some rehabilitation to restore strength and range of motion. But a cast forces you to rest your foot.

Formal physical therapy instruction can help make sure you properly stretch your Achilles tendon and plantar fascia ligament. Doctors usually consider surgery only for severe cases that do not improve.

Treatment if the condition gets worse

Your doctor may suggest corticosteroid shots if you have tried nonsurgical treatment for several weeks without success.^{footnote 1} Shots can relieve pain, but the relief is often short-term. Also, the shots themselves can be painful, and repeated shots can damage the heel pad and the plantar fascia.

Out of 100 people with plantar fasciitis, about 95 are able to relieve their heel pain with nonsurgical treatments. Only about 5 out of 100 need surgery. ^{footnote 1}If you are one of the few people whose symptoms don’t improve in 6 to 12 months with other treatments, your doctor may recommend plantar fascia release surgery. Plantar fascia release involves cutting part of the plantar fascia ligament in order to release the tension and relieve the inflammation of the ligament.

What to think about

If you are trying to lose weight and you develop plantar fasciitis when you begin exercising, especially jogging, talk with your doctor about other types of activity that will support your weight-loss efforts without making your heel pain worse. An activity like swimming that doesn’t put stress on your feet may be a good choice.

If your plantar fasciitis is related to sports or your job, you may have trouble stopping or reducing your activity to allow your feet to heal. But resting your feet is very important to avoid long-lasting heel pain. Your doctor or a sports medicine specialist may be able to suggest a plan for alternating your regular activities with ones that do not make your pain worse.

If you exercise frequently, ask your doctor whether physical therapy or referral to a sports medicine specialist, podiatrist, or orthopedist is appropriate.

Some questions you may want to ask about exercise include:

• Should I cut back on my exercise? How many days per week, how long, and what exercise should I do instead?
• Should I ice my foot after I exercise? If so, for how long each time, and how long should I continue the icing?
• Should I use nonsteroidal anti-inflammatory drugs (NSAIDs) either before or after I exercise?
• Are there exercises I can do to make my foot and ankle more flexible? What are they, and how often and how long should I do them?

Prevention

The following steps will help prevent plantar fasciitis or help keep the condition from getting worse if you already have it:

• Take care of your feet. Wear shoes with good arch support and heel cushioning. If your work requires you to stand on hard surfaces, stand on a thick rubber mat to reduce stress on your feet.
• Do exercises to stretch the Achilles tendon at the back of the heel. This is especially important before sports, but it is helpful for nonathletes as well. Ask your doctor about recommendations for a stretching routine.
• Stay at a healthy weight for your height.
• Establish good exercise habits. Increase your exercise levels gradually, and wear supportive shoes.
• If you run, alternate running with other sports that will not cause heel pain.
• Put on supportive shoes as soon as you get out of bed. Going barefoot or wearing slippers puts stress on your feet.

If you feel that work activities caused your heel pain, ask your human resources department for information about different ways of doing your job that will not make your heel pain worse. If you are involved in sports, you may want to consult a sports training specialist for training and conditioning programs to prevent plantar fasciitis from recurring.

Home Treatment

The first steps your doctor will recommend to treat plantar fasciitis are ones you can take yourself. Different people find that one method or a combination of methods works best for them.

Try the following methods:

• Rest your feet. Stop or reduce any activities that may be causing your heel pain.
• Wear supportive footwear. Wear shoes that have good arch support and heel cushioning. Or buy shoe inserts (orthotics). Shoe inserts may be made of plastic, rubber, or felt. Orthotics can reduce stress and pulling on the plantar fascia ligament.
• Use ice on your heel. Ice can help reduce inflammation. Contrast baths, which alternate hot and cold water, can also be helpful. Heat alone may make symptoms worse for some people, so always end a contrast bath with a soak in cold water. If ice isn’t helping after 2 or 3 days, try heat, such as a heating pad set on low.
• Take ibuprofen (such as Advil or Motrin), naproxen (such as Aleve), or another nonsteroidal anti-inflammatory drug (NSAID) to reduce pain and inflammation. NSAIDs come in pills and in a cream that you rub over the sore area. Be safe with medicines. Read and follow all instructions on the label.
• Wear night splints. Night splints gently stretch the plantar fascia ligament and Achilles tendon and keep them from getting tight during the night.
• Do stretching and strengthening exercises. Exercises for stretching the Achilles tendon and plantar fascia will increase their flexibility. Exercises to strengthen the muscles of the foot and ankle will help support the arch.

Often athletes develop foot problems because they train in shoes that are worn out or don’t fit properly. Replace your shoes every few months, because the padding wears out. Also, replace shoes if the tread or heels are worn down. While replacing shoes is expensive, it is less expensive—and less painful—than a long-lasting heel problem. Other sensible training techniques, such as avoiding uneven or hard surfaces, can help prevent plantar fasciitis from occurring or returning.

If your weight is putting extra stress on your feet, your doctor may encourage you to try a weight-loss program.

To be successful at treating plantar fasciitis, you will need to:

• Be patient and consistent. The majority of cases of plantar fasciitis go away in time if you regularly stretch, wear good shoes, and rest your feet so they can heal.
• Start treatment right away. Don’t just ignore the pain and hope it will go away. The longer you wait to begin treatment, the longer it will take for your feet to stop hurting.

The healing process takes time—from a few months to a year. But you should begin to have less pain within weeks of starting treatment. If you have not improved after trying these methods for 6 weeks, your doctor will suggest other treatments.

Medications

Your doctor may recommend medicine to relieve the pain and inflammation caused by plantar fasciitis. Drug treatment does not cure plantar fasciitis. But by reducing pain, medicine may make it easier for you to follow other treatment steps, such as stretching. You should not use medicine as a way to continue the activities that are causing heel pain.

Medicine options include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil or Motrin, for example) or naproxen (Aleve, for example). You can buy these medicines without a prescription. NSAIDs are often used if you have only had symptoms of plantar fasciitis for a few days or weeks. They are less likely to work if you have had symptoms for more than 6 to 8 weeks. NSAIDs come in pills and in a cream that you rub over the sore area.
• Corticosteroid shots. Your doctor may recommend shots if you have tried other treatments for several weeks without success.^{footnote 3} Doctors may recommend shots sooner for some people.

Injections of botulinum toxin are being studied for use in plantar fasciitis.

Surgery

Surgery is usually not needed for plantar fasciitis. About 95 out of 100 people who have plantar fasciitis are able to relieve heel pain without surgery. Your doctor may consider surgery if nonsurgical treatment has not helped and heel pain is restricting your daily activities. Some doctors feel that you should try nonsurgical treatment for at least 6 months before you consider surgery.^{footnote 1}

The main types of surgery for plantar fasciitis are:

• Plantar fascia release. This procedure involves cutting part of the plantar fascia ligament. This releases the tension on the ligament and relieves inflammation.
• Other procedures, such as removing a heel spur or stretching or loosening specific foot nerves. These surgeries are usually done in combination with plantar fascia release when there is lasting heel pain and another heel problem.

Experts in the past thought that heel spurs caused plantar fasciitis. Now experts generally believe that heel spurs are the result, not the cause, of plantar fasciitis. Many people with large heel spurs never have heel pain or plantar fasciitis. So surgery to remove heel spurs is rarely done.

Other Treatment

Physical therapy may be helpful for some people who have plantar fasciitis. It can be especially useful for people who have problems with foot mechanics (biomechanical problems), such as tight Achilles tendons.

A technique called extracorporeal shock wave therapy (ESWT) uses pulsed sound waves to treat plantar fasciitis. Research is still being done, but some studies show that ESWT can help reduce symptoms in plantar fasciitis that has not responded to other treatment.^{footnote 4, footnote 5} New shock wave treatments are being studied. Most types of shock wave therapy, sometimes called “focused” ESWT, require anesthetic. Another type, called radial ESWT, can be done without anesthetic, because the shock wave is more spread out.

References

Citations

1. American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Plantar fasciitis. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 839–844. Rosemont, IL: American Academy of Orthopaedic Surgeons.
2. Thomas JL, et al. (2010). The diagnosis and treatment of heel pain: A clinical practice guideline-revision 2010. Journal of Foot and Ankle Surgery, 49(3, Suppl): S1–S19.
3. American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Plantar fasciitis. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 839–844. Rosemont, IL: American Academy of Orthopaedic Surgeons.
4. Malay DS, et al. (2006). Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: Results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial. Journal of Foot and Ankle Surgery, 45(4): 196–210.
5. Gerdesmeyer L, et al. (2008). Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: Results of a confirmatory randomized placebo-controlled multicenter study. American Journal of Sports Medicine. Published online October 1, 2008.

Other Works Consulted

• Basford JR, Baxter GD (2010). Therapeutic physical agents. In WR Frontera et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 5th ed., vol. 2, pp. 1691–1712. Philadelphia: Lippincott Williams and Wilkins.
• Digiovanni BF, et al. (2006). Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. Journal of Bone and Joint Surgery, 88(6): 1775–1781.
• Orchard J (2012). Clinical review: Plantar fasciitis. BMJ. Published online October 10, 2012 (doi:10.1136/bmj.e6603).
• Pasquina PF, et al. (2015). Plantar fasciitis. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 3rd ed., pp. 463–467. Philadelphia: Saunders.

Credits

Current as of:
November 16, 2020

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP – Emergency Medicine
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Kathleen Romito MD – Family Medicine
Gavin W.G. Chalmers DPM – Podiatry and Podiatric Surgery

American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Plantar fasciitis. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 839-844. Rosemont, IL: American Academy of Orthopaedic Surgeons.

Thomas JL, et al. (2010). The diagnosis and treatment of heel pain: A clinical practice guideline-revision 2010. Journal of Foot and Ankle Surgery, 49(3, Suppl): S1-S19.

American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Plantar fasciitis. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 839-844. Rosemont, IL: American Academy of Orthopaedic Surgeons.

Malay DS, et al. (2006). Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: Results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial. Journal of Foot and Ankle Surgery, 45(4): 196-210.

Gerdesmeyer L, et al. (2008). Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: Results of a confirmatory randomized placebo-controlled multicenter study. American Journal of Sports Medicine. Published online October 1, 2008.

Plantar Fasciitis and Other Causes of Heel Pain

STEPHEN L. BARRETT, D.P.M., and ROBERT O’MALLEY, D.P.M., Spring, Texas, Columbia Kingwood Hospital, Kingwood, Texas

Am Fam Physician. 1999 Apr 15;59(8):2200-2206.

The most common cause of heel pain is plantar fasciitis. It is usually caused by a biomechanical imbalance resulting in tension along the plantar fascia. The diagnosis is typically based on the history and the finding of localized tenderness. Treatment consists of medial arch support, anti-inflammatory medications, ice massage and stretching. Corticosteroid injections and casting may also be tried. Surgical fasciotomy should be reserved for use in patients in whom conservative measures have failed despite correction of biomechanical abnormalities. Heel pain may also have a neurologic, traumatic or systemic origin.

Plantar fasciitis, the most common cause of heel pain, may have several different clinical presentations. Although pain may occur along the entire course of the plantar fascia, it is usually limited to the inferior medial aspect of the calcaneus, at the medial process of the calcaneal tubercle. This bony prominence serves as the point of origin of the anatomic central band of the plantar fascia and the abductor hallucis, flexor digitorum brevis and abductor digiti minimi muscles.

Plantar fasciitis is often referred to as “heel spur syndrome” in the literature and the medical community, but the label is a misnomer. This vague and nonspecific term incorrectly suggests that osseous “spurs” (inferior calcaneal exostoses) are the cause of pain rather than an incidental radiographic finding. There is no correlation between pain and the presence or absence of exostoses,1 and excision of a spur is not part of the usual surgery for plantar fasciitis.2 Plantar fasciitis occurs in both men and women, but is more common in the latter. Its incidence and severity correlate strongly with obesity.

Etiology

Most cases of plantar fasciitis are the result of a biomechanical fault that causes abnormal pronation. For example, a patient with a flexible rearfoot varus may at first appear to have a normal foot structure but, on weight-bearing, may display significant pronation. The talus will plantar flex and adduct as the patient stands, while the calcaneus everts. This pronation significantly increases tension on the plantar fascia.

Other conditions, such as tibia vara, ankle equinus, rearfoot varus, forefoot varus, compensated forefoot valgus and limb length inequality, can cause an abnormal pronatory force. Increased pronation with a collapse produces additional stress on the anatomic central band of the plantar fascia and may ultimately lead to plantar fasciitis.2,3 This is understandable since the weakest point of the plantar fascia is its origin, not its substance (because of the high tensile strength of the fascial fibers themselves).4

Presenting Symptoms

Patients usually describe pain in the heel on taking the first several steps in the morning, with the symptoms lessening as walking continues. They frequently relate that the pain is localized to an area that the examiner identifies as the medial calcaneal tubercle. The pain is usually insidious, with no history of acute trauma. Many patients state that they believe the condition to be the result of a stone bruise or a recent increase in daily activity. It is not unusual for a patient to endure the symptoms and try to relieve them with home remedies for many years before seeking medical treatment.

Diagnosis

Even in this age of modern technology, the diagnosis of plantar fasciitis is based mainly on the medical history and clinical presentation. Direct palpation of the medial calcaneal tubercle often causes severe pain (Figure 1). The pain is generally localized at the origin of the anatomic central band of the plantar fascia, with no significant pain on compression of the calcaneus from a medial to a lateral direction. Standard weight-bearing radiographs in the lateral and anteroposterior projection demonstrate the biomechanical character of the hindfoot and forefoot, and may show other osseous abnormalities such as fractures, tumors or rheumatoid arthritis in the calcaneus. However, radiographs usually serve only as an aid to confirm the clinician’s diagnosis.

View/Print Figure

FIGURE 1.

Palpation of the medial calcaneal tubercle usually elicits pain in patients presenting with plantar fasciitis.

FIGURE 1.

Palpation of the medial calcaneal tubercle usually elicits pain in patients presenting with plantar fasciitis.

Conservative Treatment

Conservative treatment of plantar fasciitis should address the inflammatory component that causes the discomfort and the biomechanical factors that produce the disorder. Patient education is imperative. Patients must understand the etiology of their pain, including the biomechanical factors that caused their symptoms. They should learn about home therapy that may relieve some discomfort and about recommended changes in daily activities, such as wearing appropriate athletic shoes with a significant medial arch while walking. Patients whose symptoms are associated with a recent increase in exercise should adopt a less strenuous regimen until the plantar fasciitis resolves.

The patient is fitted with a removable longitudinal metatarsal pad during the first visit. This pad, which is created from felt, 1/4-in thick, extends from the distal aspect of the medial calcaneal tubercle to about 0.5 cm proximal to the five metatarsal heads. The clinician should skive (cut or bevel) this pad so that its greatest thickness is under the medial aspect of the arch, as opposed to the lateral aspect of the foot. This pad serves as a temporary medial arch support to decrease pronation during midstance of the gait cycle.

Other clinicians favor placing a medial arch pad directly against the patient’s skin and taping the patient’s foot from a plantar medial to a plantar lateral direction using 3-in wide tape. These temporary devices provide greater biomechanical support than over-the-counter heel cups or heel pads. If a patient has significant plantar fasciitis pain secondary to a limb-length inequality or unilateral ankle equinus, a simple 1/4-in heel lift in the shoe of the affected foot may provide temporary relief.

Stretching the Achilles tendon is beneficial as adjunctive therapy for plantar fasciitis. The patient is instructed to face a wall with one foot approximately 6 in from the wall and the other foot about 2 ft from the wall, and then lean toward the wall while keeping both heels on the floor. This exercise stretches the heel cord of the limb that is farther from the wall. It should be performed with both legs forward for two minutes each, three to five times daily. This stretching program should be continued for six to eight weeks, after which time the patient is reevaluated.

Each night for 10 to 14 days, the patient should apply an ice pack to the plantar aspect of the heel 15 to 20 minutes before going to bed. An alternative approach is to massage the plantar fascia with an ice block (made up of water frozen in a paper cup) for 15 minutes per day for two weeks.

It is often advantageous for patients with no contraindication to take a nonsteroidal anti-inflammatory drug (NSAID) for six to eight weeks. We believe that corticosteroid injections should be avoided in the initial treatment of plantar fasciitis; we use them only as supplemental treatment in patients who have resistant chronic plantar fasciitis after achieving adequate biomechanical control. These injections may provide only temporary relief and can cause a loss of the plantar fat pad if used injudiciously. Typically, 3.0 mL of an equal mixture of 1 percent lidocaine, 0.5 percent marcaine and 1 mL of triamcinolone (40 mg per mL) is injected around the medial process of the calcaneal tuberosity. Solutions containing epinephrine are not used. Radiographic guidance of injection placement may aid the inexperienced practitioner.

Night splints that maintain the foot at an angle of 90 degrees or more to the ankle have recently been used as adjunctive therapy for plantar fasciitis. These orthoses prevent contraction of the plantar fascia while the patient sleeps. One study5 showed relief of recalcitrant plantar fasciitis pain in 83 percent of patients treated with such splints.

Orthotic devices are the mainstay of ongoing conservative treatment for patients with plantar fasciitis. The biomechanical factors that cause the abnormal pronatory forces stressing the medial band of the plantar fascia must be corrected. Patients with pes cavus feet may benefit from using a flexible orthotic device with an additional heel cushion. This prescription orthosis can disperse some of the force experienced on heel strike, while maintaining biomechanical support for propulsion. Prescription orthoses provide long-term relief by reducing abnormal stress on the plantar fascia.

The clinician should perform a complete biomechanical examination, checking the range of motion of the first metatarsophalangeal, midtarsal, subtalar and ankle joints, as well as the forefoot-to-rearfoot relationship, to adequately correct for any biomechanical abnormalities. To make the orthosis, the clinician should cast the foot with the subtalar joint in the neutral position, neither inverted nor everted. Casting performed in this position captures the foot deformity and allows for proper biomechanical control. A properly casted orthosis will provide biomechanical support and diminish the abnormal compensatory force that may subsequently cause plantar heel pain. Family physicians who do not elect to learn and utilize the skills necessary to provide this type of care may refer patients to podiatrists or orthopedic surgeons with an interest in such treatment.

Some clinicians advocate the use of a short-leg walking cast for several weeks as a final conservative step in the treatment of plantar fasciitis. In one study,6 a short-leg cast worn for a minimum of three weeks was found to be an effective form of treatment for chronic plantar heel pain.

Surgical Management

Adequate conservative therapy of plantar fasciitis, as described above, must be pursued for several months before any surgical intervention is contemplated. It is unwise to operate on a patient who has had only a limited trial of conservative treatment and who has incomplete control of the abnormal mechanics that have caused the symptoms. Surgical intervention may be indicated in the small percentage of patients who have failed to benefit from conservative methods and who still have significant plantar heel pain after a lengthy period of treatment.

It is well documented that plantar fasciotomy alone, without inferior calcaneal exostectomy, is an effective surgical approach to this condition5,6 (Figure 2). Endoscopic plantar fasciotomy was developed as a minimally invasive way of accomplishing this.5–7 Endoscopic plantar fasciotomy is less traumatic than traditional open heel-spur surgery and allows earlier weight-bearing after surgery. Some authorities consider the technique controversial, but a study8 of 652 endoscopic plantar fasciotomy procedures, performed by 25 different surgeons, reported a success rate (resolution of chronic plantar fasciitis) as high as 97 percent. Results of a recent study9 that compared 29 endoscopic procedures with 84 open fasciotomies with spur resection indicate that patients who underwent endoscopic plantar fasciotomy returned to work an average of 55 days sooner than those who had an open heel approach (29 days versus 84 days). Depending on their job, patients may return to work as soon as the next day. Those whose work involves standing or walking or is otherwise physically demanding may need up to eight weeks of partial weight-bearing.

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FIGURE 2.

Sagittal magnetic resonance image of fat pad, showing the complexities of the fibrous septal network, the plantar fascia and an inferior calcaneal exostosis (arrow) just superior to the plantar fascia.

FIGURE 2.

Sagittal magnetic resonance image of fat pad, showing the complexities of the fibrous septal network, the plantar fascia and an inferior calcaneal exostosis (arrow) just superior to the plantar fascia.

Other Causes of Heel Pain

Less common causes of heel pain should be considered before a treatment regimen for plantar fasciitis is undertaken. These include sciatica, tarsal tunnel syndrome, entrapment of the lateral plantar nerve, rupture of the plantar fascia, calcaneal stress fracture and calcaneal apophysitis (Sever’s disease). Rarely, systemic disorders can cause heel pain.

Sciatica

Heel pain secondary to sciatica is a result of pressure on the L5-S1 nerve root, which provides segmental innervation to the posterior thigh, and the gluteal, anterior, posterior and lateral leg muscles, as well as sensation to the heel. This nerve root is also responsible for the plantar response (ankle reflex). The sciatic nerve innervates numerous muscles along its course, and patients may experience weakness in any or all of them. They may also report sharp pain radiating down the buttocks and the posterior aspect of the thigh and leg distally toward the heel.

The patient’s lower extremities should be evaluated while the patient sits on the examination table with knees flexed. The neurologic examination should include testing of proprioception, sharp/dull sensation and reflexes (specifically the plantar reflex) to rule out polyneuropathy, sciatica and neuralgia as causes of the heel pain. The physical examination should also include the simple thigh and leg raise, which, if painful, may indicate a disorder of the lower back. The treatment of heel pain caused by sciatic root compression should be directed toward the primary pathology.

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is caused by compression of the posterior tibial nerve as it courses from the posterior aspect of the medial malleolus toward the anteromedial aspect of the calcaneus. The tarsal canal is a fibro-osseous structure bounded by the flexor retinaculum medially, the posterior aspect of the talus and calcaneus laterally, and the medial malleolus anteriorly. The tendons of the posterior tibialis, the flexor digitorum longus and the flexor hallucis longus muscles, as well as the posterior tibial nerve, artery and vein, course within this space. Compression of the posterior tibial nerve here may cause a burning sensation.

Specific conditions that may cause compression of the posterior tibial nerve include a soft tissue mass, callus from a previous fracture of the medial malleolus, inflammation of one of the tendons coursing through the tarsal canal and excessive pronation that increases tension on the posterior tibial tendon and the corresponding nerve. Patients may describe heel pain with a tingling sensation around the plantar and medial aspect of the heel. Symptoms are often exacerbated by weight-bearing and ambulation but may persist at rest.

The posterior tibial nerve is responsible for a large area of sensory innervation, and patients often experience difficulty in pinpointing their discomfort to a specific location in the heel. Unlike patients with heel pain from plantar fasciitis, those with tarsal tunnel syndrome typically describe their pain as being most intense on standing and walking after long periods of rest. They usually do not experience pinpoint tenderness at the origin of the medial band of the plantar fascia.

Physical examination should include palpation of the course of the posterior tibial nerve from the proximal aspect of the medial malleolus distally toward the anterior aspect of the calcaneus. Patients may experience an uncomfortable burning pain that radiates proximally toward the calf (Valleix sign) or distally toward the toes (Tinel’s sign).

Finally, the clinician should inspect the patient’s hindfoot for any structural conditions that may alter the patient’s biomechanics. An abnormal gait can create greater tension on the contents of the posterior tarsal tunnel, resulting in an irritation of the posterior tibial nerve.

Nerve conduction velocity studies and electromyographic tests can confirm the diagnosis of tarsal tunnel syndrome. Conservative therapy should address excessive pronation, which can cause compression of the posterior tibial nerve. Reduction of ambulation, NSAIDs, physical therapy and orthotic devices may alleviate these symptoms. Patients who do not respond sufficiently to conservative therapy may require surgical decompression of the tarsal canal.

Entrapment of the Lateral Plantar Nerve

Entrapment of the first branch of the lateral plantar nerve, which provides innervation to the abductor digiti quinti muscle, has been said to cause plantar medial heel pain. The entrapment usually occurs between the abductor hallucis muscle and the quadratus plantae muscle, giving patients a burning sensation on the plantar aspect of the heel that is aggravated by daily activities and may even persist at rest. Palpation of this area may prove painful, with a tingling sensation. The same conservative modalities that are used to treat plantar fasciitis are effective in treating this condition.

Plantar Fascial Rupture

Rupture of the plantar fascia is an uncommon cause of plantar heel pain. Patients often report severe pain in the medial arch following physical trauma. Some patients have been misdiagnosed and treated unsuccessfully for several months with steroid injections for presumed plantar fasciitis. Magnetic resonance imaging can aid greatly in the diagnosis of this condition.

Physical examination may reveal a palpable deficit in the plantar fascia or a small enlarged area at the distal aspect of the plantar fascial rupture. Patients also experience severe pain on palpation of the plantar fascia, with maximal tenderness generally distal to the medial process of the calcaneal tuberosity. Gait analysis usually reveals a significant limp that spares the affected limb. Treatment consists of immobilization with a nonweight-bearing short-leg cast or a removable boot cast and a regimen of NSAID therapy. Immobilization for four to six weeks is usually required before ambulation without pain is possible.

Calcaneal Stress Fracture

Acute heel pain caused by calcaneal stress fractures can closely resemble the symptoms usually associated with plantar fasciitis. The history may reveal a recent abrupt increase in daily exercise or other activities. Patients with this condition often report increased pain on direct medial to lateral compression of the calcaneus (Figure 3). This type of elicited pain is rarely present in patients with plantar fasciitis.

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FIGURE 3.

Medial to lateral compression of the calcaneus typically causes pain in patients with calcaneal stress fracture.

FIGURE 3.

Medial to lateral compression of the calcaneus typically causes pain in patients with calcaneal stress fracture.

Conservative therapy involves educating patients to limit activities that make the pain worse. Patients are advised to wear athletic shoes all day (they diminish the forces of heel strike) and are instructed to moderate their activities for three weeks. If the symptoms are not relieved significantly in three weeks, the patient is reevaluated, and the foot is placed in a removable cast boot.

Calcaneal Apophysitis

Calcaneal apophysitis (Sever’s disease) usually affects boys between six and 10 years of age, chiefly those who are obese and those who are extremely active. In most cases, the pain is located in the posterior aspect of the calcaneus and is more severe after athletic activity.

Palpation of the posterior aspect of the calcaneus around the insertion of the Achilles tendon usually reveals local tenderness. Patients with this disorder may have a tight Achilles tendon with limited ankle dorsiflexion, which sometimes causes patients to walk on their toes to decrease the pain.

The treatment is usually simple. All strenuous, high-impact activities are discontinued during the initial phase of treatment, and heel lifts, ice massage and appropriate NSAID therapy are prescribed. This regimen is followed (as soon as inflammation is decreased to a point that stretching is not painful) by stretching exercises to achieve adequate dorsiflexion of the ankle joint. Orthotic devices can be prescribed after the acute inflammation has resolved to reduce the probability of recurrence. Cast immobilization is occasionally necessary in patients whose symptoms do not resolve in a timely manner and in noncompliant children.

Systemic Disorders

Heel pain may occur in patients with various systemic inflammatory conditions, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Reiter’s syndrome, gout, Behçet’s syndrome and systemic lupus erythematosus.10–18 Gonorrhea and tuberculosis have also been implicated as causes of heel pain, but such an association is rare.19

Most patients with systemic disease present with joint pain and inflammation in other areas of the body, but symptoms may occasionally begin in the heel. A detailed history and physical examination may disclose the symptom complexes of an arthritic disease. For example, a young man who reports bilateral heel pain and who has a history of conjunctivitis or urethritis for more than one month may have Reiter’s disease. Similarly, heel pain in a patient with a history of psoriasis and asymmetric pain in the distal inter-phalangeal joints of the fingers and toes should raise the possibility of psoriatic arthritis. When heel pain is of systemic origin, treatment should, of course, be directed at the primary disease state. Radiographs of patients with systemic inflammatory conditions may show posterior or plantar exostoses, but these findings are not clinically important.

The number of patients whose heel pain is caused by systemic arthritic diseases is small in comparison to those with pain from other causes, but these arthritic diseases must be ruled out through appropriate physical examination and laboratory studies before the heel pain is treated.

Heel Pain | FootCareMD

What Is Heel Pain?

Every mile you walk puts tons of stress on each foot. Your feet can handle a heavy load, but too much stress pushes them over their limits. When you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues, you may
develop heel pain, the most common problem affecting the foot and ankle.

A sore heel will usually get better on its own without surgery if you give it enough rest. However, many people ignore the early signs of heel pain and keep on doing the activities that caused it. When you continue to walk on a sore heel, it will only
get worse and could become a chronic condition leading to more problems.

Diagnosis

Heel pain can have many causes. If your heel hurts, see your primary care doctor or foot and ankle orthopaedic surgeon right away to determine the cause and get treatment. Tell him or her exactly where you have pain and how long you’ve had it. Your doctor will examine your heel, looking and feeling for signs of tenderness and swelling. You may be asked to walk, stand
on one foot, or do other physical tests that help your doctor pinpoint the cause of your sore heel. Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel. 

Pain Beneath the Heel

If it hurts under your heel, you may have one or more conditions that inflame the tissues on the bottom of your foot:

• Stone bruise: When you step on a hard object such as a rock or stone, you can bruise the fat pad on the underside of your heel. It may or may not look discolored. The pain goes away gradually with rest.
• Plantar fasciitis (subcalcaneal pain):
  Doing too much running or jumping can inflame the tissue band (fascia) connecting the heel bone to the base of the toes. The pain is centered under your heel and may be mild at first but flares up when you take your first steps after resting overnight.
  You may need to do special exercises, take medication to reduce swelling, and wear a heel pad in your shoe.
• Heel spur: When plantar fasciitis continues for a long time, a heel spur (calcium deposit) may form where the fascia tissue band connects to your heel bone. Your doctor may take an X-ray to see the bony protrusion. Treatment usually
  is the same as for plantar fasciitis: rest until the pain subsides, do special stretching exercises and wear heel pad shoe inserts. Having a heel spur may not cause pain and should not be operated on unless symptoms become chronic.  

Pain Behind the Heel

If you have pain behind your heel, you may have inflamed the area where the Achilles tendon inserts into the heel bone (retrocalcaneal bursitis). People often get this by running too much or wearing shoes that rub or cut into the back of the heel. Pain
behind the heel may build slowly over time, causing the skin to thicken, become red and swell.

You might develop a bump on the back of your heel that feels tender and warm to the touch. The pain might flare up when you first start an activity after resting. It often hurts too much to wear normal shoes. You may need an X-ray to see if you also have
a bone spur.

Treatment

Treatment includes resting from the activities that caused the problem, doing certain stretching exercises, using pain medication, cushioned heel cups, and wearing open-back shoes.

• Your doctor may want you to use a 3/8″ or 1/2″ heel insert.
• Stretch your Achilles tendon by leaning forward against a wall with your foot flat on the floor and heel elevated with the insert. Stretching your Achilles on a stepstool also can be helpful.
• Use nonsteroidal anti-inflammatory medications for pain and swelling.
• Consider placing ice on the back of the heel to reduce inflammation.

Last reviewed by Sudheer Reddy, MD, 2020

The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute
for professional medical advice, diagnoses or treatments. If you need medical advice, use the “Find a Surgeon” search to locate a foot and ankle orthopaedic surgeon in your area.

Heel Pain Doctors | Heel Pain Treatment

We are your Heel Pain Doctors!  We have offices in Livonia, Novi, Howell, & Southfield to service you!

Heel Callus

Heel calluses, also called plantar calluses, develop when one metatarsal bone is longer or lower than the others and it hits the ground with more force than it is equipped to handle-at every step. As a result, the skin under this bone thickens like a rock in your shoe. The callus causes irritation and pain.

Sometimes, an osteotomy procedure is performed to relieve the pressure on the bone. The procedure will involve cutting the metatarsal bone in a “V” shape and lifting the bone and aligning it with the other bones.

Heel Fissures

Heel fissures, or cracking of the skin of the heels, are an often painful condition that can cause bleeding. Open-backed sandals or shoes, which allow more slippage around the heel while walking, are often the culprits. The skin thickens as a result of the friction.

Plantar Fasciitis (heel spur)

Plantar fasciitis (or heel pain) is commonly traced to an inflammation on the bottom of the foot. Our practice can evaluate arch pain and may prescribe customized shoe inserts called orthoses to help alleviate the pain.

Plantar fasciitis is caused by inflammation of the connective tissue that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Also called “heel spur syndrome,” the condition can usually be successfully treated with conservative measures such as the use of anti-inflammatory medications and ice packs, stretching exercises, orthotic devices, and physical therapy.

Heel Pain: Definition, Causes, Diagnosis, and Treatment 

Heel Pain – an overview 

Heel pain is a common chief complaint seen in hospitals and private clinics. 

According to one report, the prevalence of plantar heel pain in the population is around 9.8%. As for debilitating plantar heel pain, the numbers are not better, with up to 7.9% of the population dealing with functional disability. 

The reason behind the high prevalence of heel pain boils down to the complex anatomy of the ankle region, which consists of 26 bones, 33 articulations, and around 100 tendons. 

The severity of the pain ranges from mild to disabling, which is why you should consult with your doctor to get further evaluation. 

In this article, we will briefly cover the causes of heel pain, such as plantar fasciitis, then switch gears to the diagnosis and treatment options.

Causes of Heel Pain 

The causes of heel pain are diverse and include: 

Plantar fasciitis 

Plantar fasciitis occurs when your feet are under too much pressure. 

By far, this condition is the most common cause of heel pain, with 1% of the U.S. population reporting the diagnosis. 

When the plantar fascia gets stretched too far, the soft tissue becomes inflamed. The site of the inflammation is typically around the insertion of the fascia to the heel bone, which explains the pattern of the pain. 

Sprains and strains 

Sprains and strains are extremely common injuries that result from a process of wear and tear. 

Achilles tendonitis (AT) 

AT describes the active inflammation of the tendon that attaches the calf muscles to the heel. As a result, receptors in your heel send signals to the brain, leading to sensations of pain. 

Bursitis 

Bursae are fluid-filled sacs located in several areas around the body, especially your joints. 

When the bursae located in your heel become inflamed, they swell up, causing pain in that region. 

Heel bumps 

Also known as pump bumps, heel bumps are common in adolescents. In these subjects, the heel is not yet mature, predisposing it to the formation of bumps after excessive rubs. 

The primary trigger of heel bumps is having a flat foot or wearing high heels at an early age. 

Tarsal tunnel syndrome 

Similar to carpal tunnel syndrome, this condition results from the entrapment of a large nerve, which triggers symptoms of neuropathy (e.g., pain, numbness). 

Stress fracture 

Repetitive stress, high-intensity exercise, and heavy manual work have all been linked to stress fractures. 

For instance, runners are particularly prone to stress fractures of their metatarsal bones of the foot. However, osteoporosis is a more common cause of stress fractures. 

The diagnosis of heel pain 

When you visit our clinic, your doctor will take your medical history and perform a thorough physical examination of the foot. 

You may expect questions such as: 

• How much walking/standing can you do before the pain becomes too severe to move? 
• What type of footwear do you use on regular days and during exercise? 
• Do you have any concurrent medical conditions? 
• Are you taking any drugs to treat other diseases? 

The next step is to examine and test the muscles in order to identify any dermatological or neurological conditions. 

For instance, squeezing the heel help your doctor differentiate between a nerve problem, the presence of a cyst, or a bone fracture. 

While these steps are usually sufficient, your doctor may need to order additional tests (e.g., blood tests, imaging scans). 

After collecting information from your medical history, clinical examination, and results of tests, your doctor will pinpoint a diagnosis for your heel pain and start a treatment plan. 

Treatment of Heel Pain 

If you are dealing with heel pain, here are some ways to relieve it: 

• Avoid any form of strenuous exercise. 
• Apply ice on your heel for 15–25 minutes. 
• Take over-the-counter painkillers (e.g., acetaminophen). 
• Wear comfortable shoes that don’t irritate the heel. 
• Wear a night splint (a device that stretches the foot while you sleep). 

In case these methods are unsuccessful in relieving your pain, it may be time to visit your doctor or podiatrist to get a tailored treatment approach. 

After taking your history and performing a thorough physical examination, your doctor may order a foot X-ray to narrow down the cause of your heel pain. Once the etiology (i.e., cause) is clear, treating your pain becomes more effective. 

In some cases, you may also need physical therapy, especially when your heel pain is chronic. This will strengthen the muscles and tendons around your foot to prevent further damage. 

In extremely rare cases, your doctor may suggest undergoing surgery to repair the injury once and for all. However, this method is not always the best approach since it requires a long duration of recovery, and in many cases, heel pain doesn’t subside. 

Advanced treatment at Michigan Podiatry 

Extracorporeal shock wave therapy – ESWT is mainly reserved to treat plantar fasciitis by releasing high-frequency shock waves that reduce inflammation and relieve pain. 

Platelet-rich plasma – throughout many research papers, scientists found that PRP accelerates recovery after traumatic injury by promoting the release of repair agents. Using PRP to treat heel pain is a fantastic way to prevent relapses. 

Stem cell therapy – stem cell therapy involves the injection of cells with endless differentiation properties. These cells can repair the damaged tissues seen with several illnesses listed above and restore the lost functions. 

MLS laser – the MLS Laser uses specific wavelengths of light to treat heel pain. The wavelengths stimulate the regeneration at the cellular level without putting you at risk of thermal injuries that other lasers may inflict. 

Botox – you’ve probably heard of Botox as the magical substance that smooths out wrinkles and subsides signs of aging. However, the same properties of this compound (i.e., muscle relaxant) can also relieve pain and pressure when the heel area is inflamed. 

Cortisone injections – injecting corticosteroids (e.g., cortisone) into the site of inflammation is one of the most efficient ways to accelerate recovery. 

Minimally invasive surgical procedures – these techniques are minimally invasive, but they lead to similar results as conventional surgery. Many athletes prefer this option to get back to the competition as soon as possible. 

When to see a doctor? 

Simple heel pain responds greatly to home remedies that involve resting, applying ice, and taking over-the-counter (OCT) painkillers. 

However, if your symptoms do not improve within 2–3 weeks, it might be time for a doctor’s visit. 

In case you experience any of the following symptoms, you should contact your doctor immediately: 

• Severe pain that does not improve with OCT painkillers 
• The abrupt nature of the pain (i.e., starts suddenly) 
• Notable redness around the heel 
• Extended swelling in the heel and ankle regions 
• The inability to walk due to severe pain 

If you live in the following areas, you can book an appointment with our excellent team of doctors at Michigan Podiatry by clicking on this link: 

• Livonia, Michigan. 
• Novi, Michigan. 
• Southfield, Michigan. 
• Howell, Michigan 

Heel pain prevention 

Preventing heel pain through avoiding injury is the best approach to this issue. However, do not expect zero risk even after taking every precautionary measure. 

Steps to Reduce Your Risk of Heel Pain: 

• Wear the right shoes for you, especially during exercise. 
• Always warm up and stretch your muscles before working out. 
• Pace yourself during physical activity. 
• Maintain a healthy diet to prevent low-grade inflammation, which is a common trigger of musculoskeletal injuries. 
• Take frequent breaks when you feel tired during work. 
• Work toward maintaining a healthy weight, as obesity increases the pressure applied on your heel. 

Takeaway message 

Heel pain is a common symptom that most people experience at some point. Most patients with heel pain have faulty foot mechanics that contribute to their condition.  Custom orthotics, placed in your shoes,  reduce mechanical stress to your feet and help resolve painful symptoms. Our doctors at Foot Healthcare Associates, utilize precision made orthotic devices to provide our patients with the best results in resolving heel pain.

If you are having problems with heel pain, please contact our heel pain doctors today at 248.258.0001 to schedule an appointment in Novi, Livonia, Howell, or Southfield. Your Heel Pain treatments are covered by most insurances.

90,000 Heel pain – causes of occurrence, under what diseases it occurs, diagnosis and treatment methods

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For a diagnosis and correct treatment prescription, you should contact your doctor.

Heel pain: causes of occurrence, under what diseases it occurs, diagnosis and treatment.

Definition

Pain in the heel area not only causes discomfort, but also makes it impossible for a person to stand for a long time and move normally. Pain is usually caused by inflammatory changes in the tissues surrounding the calcaneus and is often long-term and recurrent. The calcaneus is the largest of all bones in the foot and carries the most stress when walking.

Varieties of heel pain

Depending on the disease that is accompanied by pain in the heel, the nature of the pain syndrome will differ.Possible acute pain when walking and standing. The pain can appear in the morning, when a person gets up from sleep, then it diminishes or disappears completely. In other cases, heel pain is aching in nature and is not related to the load on the leg. In a number of diseases, pain bothers not only when walking, but also at night, at rest. Sometimes, along with the pain, numbness, tingling and “goose bumps” are felt, the skin may redden, and edema appears.

The pain can increase with the extension of the foot, and in some cases, it causes limited mobility in the ankle joint.

Possible causes of heel pain

The causes of heel pain can be divided into physiological and pathological. The former include overexertion of the foot due to wearing uncomfortable shoes or shoes with flat soles and without an instep support, due to prolonged standing, due to increased stress on the foot during pregnancy or with rapid weight gain.

Various diseases and injuries are the pathological causes.

Achilles tendinitis and plantar fasciitis (heel spur) .With physical exertion and overstretching of the tendons attached to the heel bone, their inflammation occurs, which manifests itself as pain in the heel and in the tendon area during physical exertion, local edema on the back of the heel, and a feeling of weakness in the ankle joint. Flexion and extension of the foot is painful. Achilles tendonitis (Achillodynia) is often the result of spondyloarthritis (a disease of the intervertebral discs), joint hypermobility (hereditary disease or predisposition), flat feet, shortening of one of the lower extremities due to a skewed pelvis with intervertebral hernias.

Plantar fasciitis, or heel spur, is also characterized by inflammation of the plantar ligamentous apparatus. The consequence of this process is the formation of a heel spur, that is, marginal bone growths (osteophytes). Patients report pain when walking and standing over the entire plantar surface of the foot.

Most often, the pain makes itself felt at the first steps after a night’s sleep or prolonged sitting.

Tarsal tunnel syndrome is characterized by damage to the fibers of the tibial nerve due to its compression between the ankle ligaments during injuries, bone growths and soft tissue tumors.The syndrome is accompanied by a burning pain and tingling sensation in the heel and sometimes the entire sole. The pain increases with the extension of the foot. Changes in the sensitivity of the skin in the sole area are possible. In tarsal tunnel syndrome, the functions of the foot and gait are often impaired.

Traumatic injuries of the calcaneus (contusion, crack, fracture) . Injury to the heel bone is more likely to occur when falling or jumping from a height in an upright position. A strong blow leads to a bruise or violation of the integrity of the bone (often combined with fractures of other bones of the lower extremities) and causes severe pain, inability to support the heel, and edema that covers the foot and lower leg.

Damage to the calcaneus is rarely accompanied by an external violation of the integrity of the soft tissues, more often hematomas are noted on the lateral surfaces of the foot.

Achilles bursitis – the disease is characterized by inflammation of the bursa, which is located between the calcaneal tendon and the calcaneus, and is manifested by pain in the lower and back of the heel, at the point of attachment of the Achilles tendon to the calcaneal tuberosity, redness and edema in the area of ​​the calcaneal tuberosity, as well as mobility of the foot.The causes of Achilles bursitis can be traumatic injuries due to wearing tight shoes, excessive physical exertion on the ankle joint, Haglund deformity. Less often, the disease is caused by metabolic and hormonal disorders, allergic reactions, autoimmune diseases, infections.

Reactive arthritis – arthritis of the joints, part of which is the calcaneus (joints of the calcaneus with the bones of the tarsus – talus and scaphoid).

The disease develops as a consequence of the transferred infectious diseases (most often – urogenital).

Pain syndrome appears in two weeks – a month after the infection. Severe pain is felt not only during exertion, but also at rest. Both heels may be affected, with swelling and redness.

Infectious diseases (tuberculosis, gonococcal infection, heel bone osteomyelitis) is a rather rare cause of heel pain. Mycobacterium tuberculosis and gonococci can develop in cancellous bones and epiphyses of tubular bones, which leads to their local destruction.The process is accompanied by pain, swelling in the ankle joint and redness. The mobility of the foot is impaired.

Haglund’s deformity – ossification of the calcaneus, in which bone-cartilaginous growth occurs in the area of ​​the calcaneal tuberosity, accompanied by the appearance of an outgrowth (osteophyte) in the area of ​​attachment of the Achilles tendon. Such a pathology can be caused by a high arch or planovalgus deformity of the foot (a combination of flat feet and hallux valgus – deviations of the big toe towards the rest of the fingers), a decrease in the elasticity of the tendons.

Hallux valgus

Constant friction of the Achilles tendon leads to the development of inflammation and changes in cartilage, sometimes with the formation of sharp spines. Patients may notice a hard bump on the back of the heel. The function of the foot, as a rule, is not impaired, but inflammation of the joint capsule and tendon sheath leads to pain syndrome when walking, and sometimes at rest.

The disease is more common in young women due to wearing uncomfortable high-heeled shoes.

Epiphysitis of the calcaneus – this disease develops in children aged 8-15 years due to a violation of the processes of ossification (ossification) of the calcaneus. Normally, the calcaneus is formed as a result of the activity of two centers of ossification. One of them functions from the birth of a child, the other from about 8 years old. Cartilaginous tissue is located between the centers of ossification, which eventually transforms into bone. In the event of an overload of the cartilage tissue between these two areas, cartilage degradation or partial rupture is possible, which is accompanied by inflammation and pain on the back and side of the heel, which increases with stress.There is a limitation of the range of motion, and with a rupture of the cartilage – swelling and redness.

Osteochondropathy of the apophysis of the calcaneus tuberosity, or Haglund-Schinz disease – the disease is characterized by aseptic (non-infectious) necrosis of the calcaneus tuberosity, which occurs due to its injury, wearing uncomfortable shoes, due to hereditary predisposition and hormonal imbalance. Tendons attached to the tubercle, when overstrained, constantly injure the bone, which causes pain and swelling, which intensify after exercise and when the foot is extended.A swelling can be seen above the calcaneal tuberosity. It has been noticed that Haglund-Schinz disease is more common in girls aged 12-16 years.

To reduce the severity of pain, patients lean on their toes when walking.

Heel pain can be caused by dermatological and vascular pathologies, which are diagnosed in patients with diabetes mellitus (trophic ulcers in diabetic foot syndrome), with varicose veins, thrombophlebitis. Patients experience slight twitching, pulling pain, rapid fatigue.There are swelling of the feet, intermittent claudication.

Which doctor should i contact for heel pain

For heel pain, especially in case of injury, it is recommended to consult an orthopedic traumatologist. In some cases, consultation with an infectious disease specialist and other specialists is required to determine the diseases that caused the pain.

Diagnosis and examinations for pain in the heel

When pain in the heel appears, a thorough history and instrumental examination are necessary.First of all, a clinical blood test is prescribed, as well as tests for infectious diseases – chlamydial and gonococcal infections, tuberculosis.

Heel pain when walking – causes and treatment | Med-magazin.ua

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Date of publication: 07.10.2019

The tense rhythm of life “on the run” often makes itself felt at the end of the working day, when the legs are simply “buzzing” with fatigue.This is especially true for people who, by the nature of their work, spend the whole day on their feet. The usual thing, rested – and everything passed. Frequent heel pain, however, should not be ignored.

Why does heel hurt when walking? It is then that the load on the foot increases. The causes of heel pain when walking can be very different. From minor, not requiring treatment, to very serious, up to surgical intervention.

To find the cause of the pain, you first need to find out what kind of pain the person is worried about.Acute heel pain when walking in the morning is characteristic of chronic inflammation in the heel muscle. This disease is called plantar fasciitis (heel spur). This disease most often develops against the background of longitudinal flat feet. In this case, an incorrect distribution of the load on the foot occurs, which leads to deformation of the tendon. Because of this, inflammation begins in the places where the tendon is attached to the bone. Against this background, bone growths may appear, which are called “heel spurs”.The disease does not develop immediately and manifests itself gradually. One of the first signs of fasciitis is severe pain in the heels when walking in the morning, subside by the middle of the day, and renewed in the evening. Feels like a person stepped on a shard of glass or a nail. If the disease is not treated, then so severe pain in the heels develops when walking that it is difficult for a person to move around. The ankle bandage for the heel spur will help here – a special orthopedic product that relieves unnecessary stress on the foot.In addition, the brace reliably fixes the ankle, which helps to reduce pain when walking. Also indicated are medication, physiotherapy and massage.

But heel pain when walking can have other causes. They can be distinguished by the nature of the pain.

1. Numbness in the heel that accompanies pain may indicate a compressed nerve from varicose veins, sprains, or other injury.
2. Calcaneal apophysitis can cause pain in the back of the heel.This is a disease in which inflammation of the nucleus of the bone develops during its formation. Occurs in adolescence.
3. Pain in the center of the heel occurs with achillobursitis. In this case, the tendon is affected and swelling occurs. To avoid the development of serious pathologies, the leg needs rest. Treatment is carried out only by a doctor.

Also, pain near the heel when walking can be the result of illness or injury to the musculoskeletal system.

• Bursitis is an inflammatory process in the heel tendon. Wearing the wrong tight shoes often contributes to it. Usually, eliminating the cause of the disease stops the pain.
• Osteochondrosis of the spine in the lumbar region, radiating to the heel and back of the thigh.
• Osteoporosis affecting the entire skeleton. It occurs due to a lack of calcium in the body.

In addition to the above reasons, heel problems can be caused by such reasons as rough skin, dry calluses, cracked heels.In turn, such problems can be caused by:

• metabolic disorders,
• lack of vitamins,
• gastritis,
• diabetes mellitus,
• fungal lesions of the skin of the heels.

As you can see, the causes of pain in the heels are very different. Accordingly, the treatment depends on the correct diagnosis. Therefore, when pain occurs, do not delay the visit to the doctor.Which doctor should I go to? To a neurologist, rheumatologist, orthopedic surgeon, traumatologist.

Compliance with the sparing regimen until the diagnosis is clarified will also be beneficial. Also recommended:

1. Eliminate excessive loads on the foot, give rest to the legs,
2. Refuse high heels or no heels at all, wear comfortable shoes,
3. Reduce weight if necessary,
4. If trauma is excluded, do remedial gymnastics for the feet.

90,000 Heel cancer symptoms, signs, treatment, stages

Heel cancer: diagnosis, treatment

What is

Heel cancer is a tumor in the heel bone. It arises due to the fact that malignant changes have occurred in the tissues.

The risk of the disease increases if the heel bone has already been damaged due to inflammation or fracture, as well as any traumatic effect on the bone tissue.

Also, heel cancer can occur due to metastasis from other organs through the lymph or blood.

Reasons

There are several possible causes of heel cancer:

• Radiation therapy affecting the heel, foot or lower leg;
• Fracture or other injury to the bone of the heel;
• Arthritis or other chronic bone disease;
• Osteomyelitis, which is inflammation of the bones of a purulent nature.

Symptoms

Heel cancer symptoms can be divided into two groups.

Nonspecific symptoms

They arise in the initial stages of the disease. They can also be present in other non-cancerous diseases, so it is not easy to diagnose foot cancer at an early stage. Let’s list these symptoms:

• Painful – when walking, pressure on the heel, a person experiences pain in it, which disappears at rest;
• Tissue swelling near the bone;
• Increase in heel size due to tumor growth;
• Fixation of the foot and limitation of movement do not relieve pain.

Specific symptoms

These are typical symptoms of heel cancer. They are as follows:

• Expansion of edema due to the spread of the disease to areas close to it;
• Severe pain at night, poor sleep;
• Density and immobility of a neoplasm attached to adjacent tissues when palpated;
• Redness of affected areas of the heel;
• Increased temperature at the heel location.

Development of the disease

With the further development of the disease, the following picture is observed:

• Loss of functionality of nearby muscles;
• Loss of joint mobility;
• Inability to bend and straighten the leg to the end;
• Restriction of movement and staying in one position to reduce pain;
• Appearance of weakness, loss of appetite, fever and weight loss;
• Further metastasis throughout the body through the bloodstream and lymph, the development of new cancer foci.

Diagnostics

Inspection

If the oncologist suspects heel cancer, then he examines the limb, finds out if there is swelling and redness in the heel area. The doctor palpates the affected area, looks to see if the patient has a problem with motor activity.

X-ray

With the help of radiography, the area of ​​the disease is determined. If it is malignant, then the picture will be light with implicit outlines.

Scintigraphy

This modern method is a bone scan. The image will show the condition of the bone tissue.

Biopsy

This is a procedure for collecting cells for analysis, which will show if there are cancer cells in the collected tissue.

MRI and CT

These procedures will allow you to see if there are metastases in the body, what is their location, size, structure, what is happening in the tissues adjacent to them.

Histology

This analysis is performed in order to obtain the most accurate information about the development of pathology.

Treatment

The nature of the treatment depends on the diagnosed stage of the disease. If the disease is in the first or second stage, then the question arises of a surgical operation that can help in the fight against cancer. Radiation therapy and chemotherapy will be auxiliary at this stage.

If the disease has passed into the third or fourth stage, then the operation will no longer be effective.The main thing here will be the non-proliferation of metastases to other organs and the slowing down of the growth of a malignant tumor. Therefore, the main methods of treatment will be radiation therapy and chemotherapy. The patient is also given strong pain relievers to relieve pain.

Forecast

In the early stages of heel cancer, the prognosis is generally good. The patient will be able to heal and return to normal life.

In the later stages, the mortality rate increases significantly, so at the first suspicion of cancer, contact the Onco clinic.Rehab.

Heel spur treatment

A fairly common condition that causes heel pain is the heel spur (plantar fasciitis).

The causes of the heel spur.

Most often it occurs as a result of inflammatory and degenerative changes in connective tissue, accompanying diseases such as arthritis, polyarthritis, ankylosing spondylitis. Also, the cause of heel pain can be prolonged overload and trauma, in particular in athletes.The main symptom is localized heel pain. Such pains are called “starting” pains – they arise either in the morning hours or after a long period of rest (sitting, lying). Under stress, for example, when walking, the pain in the heel becomes intense, very sharp.

The risk of a heel spur is higher in overweight people, metabolic disorders (gout, diabetes mellitus), flat feet or trophic disorders of the lower extremities.

The population most prone to heel spur pain are women over forty.

What is a heel spur?

The mechanism of occurrence of the disease is approximately as follows – in an upright person, about half of the body weight presses on the connective tissues at the site of attachment to the heel tuber. With prolonged or excessive exertion, micro-ruptures occur with the further addition of inflammation and growth of bone tissue due to the deposition of salts, the so-called spur on the heel, similar to a pointed thorn, causing acute pain when walking.

Folk remedies for heel spur.

As a rule, persistent pain syndrome occurs when it is no longer possible to cope with the process at home and folk remedies for the treatment of heel spurs are not able to cure the disease, which significantly reduces the patient’s quality of life. For prolonged pain in the heel or foot, see a doctor.

Comprehensive treatment of heel spurs.

Treatment of a heel spur should be comprehensive.In addition to general recommendations for a heel spur – an active lifestyle, but with dosing of the load, avoiding overloading the foot, timely treatment of arthritis, if there is a correction of flat feet, control over body weight – examination and consultation with a doctor are necessary. Medical Center “Zvezda” invites you to undergo an examination in case of pain when walking and, if necessary, take a set of measures aimed at treating plantar fasciitis. A highly qualified doctor will prescribe the necessary drug therapy for inflammatory processes and relieve pain syndrome, including blockades, give professional recommendations on physiotherapy exercises and orthopedic measures to correct the load on the foot, prescribe a comprehensive physiotherapy treatment that can be done on the spot without wasting time looking for a medical institutions offering similar services.

In addition to the radical – surgical method of treatment, modern conservative methods are currently used – shock wave therapy, laser therapy, magnetic therapy, ultrasound treatment.

Medical Center “Zvezda” offers a modern and effective method of heel spur treatment – Shock Wave Therapy.

The SWT method allows to achieve a local improvement in microcirculation, improve the permeability of cell membranes and block the transmission of nerve impulses in tissues, which makes it possible to achieve instant relief of pain.Muscle tone is restored, tissue regeneration is achieved and pain syndrome is significantly reduced.

Heel pain? – how to understand what is the reason and how

is treated

Heel pain can result from excessive stress on the feet, which have a cushioning function while walking or running. But some people have heel pain as a result of injury or the development of a serious medical condition that requires immediate medical attention. The diagnosis and treatment of such a problem is dealt with by an orthopedic traumatologist, who should be visited as soon as possible if the symptoms persist and worsen.Treatment depends on the cause of the pain that has arisen and involves the use of medications, the performance of special exercises, the wearing of orthopedic shoes, which will evenly distribute the load on the musculoskeletal system.

Contents:

What is heel pain?

Heel pain often occurs in people who spend most of their time on their feet. The increased load on the feet leads to inflammation of the soft tissues, resulting in unpleasant discomfort.

A child can also complain that his heel hurts, it hurts to step on one foot. If the symptom does not go away, but only gets worse, it is necessary to show it to a pediatric orthopedist as soon as possible. During adolescence, especially if the child is active, some develop a serious illness called Haglund-Schnitz disease. This pathology is a necrosis of the bone tissue of the calcaneal tuberosity. Why some children are susceptible to such a disease, doctors still cannot answer for sure.However, a number of predisposing factors have been identified:

• hereditary predisposition;
• overweight;
• violation of metabolic processes;
• hormonal imbalance;
• excessive physical activity;
• foot injuries.

From the foregoing, it can be concluded that persistent pain in the heel is associated with inflammatory or degenerative-deforming processes caused by both internal and external factors.Therefore, if every day it becomes worse for a person to step on the heel, he needs urgent medical attention. Treating a disease without finding out its cause is fraught with serious complications.

Why do heels of feet hurt

The foot performs a supporting and shock-absorbing function for the whole body, since during movement it is on the feet that the heaviest load is exerted. When the load suddenly increases, the muscles of the foot do not have time to adapt so quickly to new conditions, resulting in sprains, inflammation, and pain in the heel when walking.More often than others, people involved in jogging and other active sports face this problem. In these cases, another reason for this syndrome may be the lack of warm-up before a sharp increase in the volume of physical activity.

But discomfort in the feet is provoked not only by sports loads. Many have a heel pain on the leg as a result of the negative impact on the musculoskeletal system of factors such as:

• overweight;
• footwork;
• uncomfortable shoes;
• development of systemic diseases;
• injuries, bruises, sprains;
• sedentary lifestyle;
• chronic infections;
• oncology.

Therefore, if an adult or a child has a heel pain, the cause of the pain should be clarified first. This will help the doctor choose the correct therapy regimen and cure the pathology.

Diseases that cause heel pain

Common diseases in which the heel hurts severely during exertion and walking:

• plantar fasciitis;
• plantar fasciitis, aka heel spur;
• stress fracture of the heel bone;
• Achilles tendon inflammation;
• calcaneal bursitis;
• tarsal tunnel syndrome;
• bruise or heel cushion syndrome.

Plantar plantar fasciitis is an inflammatory disease in which pathological processes are localized in the plantar ligament or fascia. Under the influence of negative internal and external factors, inflammation develops in the fascia, the progression of which is accompanied by pain symptoms and problems with walking.

With this disease, acute pain in the heel from the inside worries, not only during exercise, but also at rest. The discomfort is increased if the patient lifts his fingers.

Common causes of plantar ligament inflammation:

• excessive physical activity;
• overweight;
• muscle imbalance;
• deformation processes in the spine;
• flat feet;
• autoimmune disorders;
• metabolic diseases, for example, diabetes mellitus;
• cardiovascular pathologies;
• age-related irreversible tissue changes.

Another common disease in which the heel hurts on the right or left leg is a heel spur or plantar fasciitis. The disease can occur at any age. The cause of its occurrence is a chronic injury to the plantar fascia and the formation of bone growth in this area. The mechanism of development of the heel spur is simple. Under the influence of negative factors, the tissues of the plantar fascia are overstretched, injured and inflamed. Inflammation can spread to adjacent areas of the foot, causing inflammation of the deep mucous membranes and periosteum.

In the place where the fascia is attached to the calcaneus, calcium salts gradually collect, which cause the formation of a hard build-up. Over time, the calcified area grows in size. On an X-ray, it looks like a pointed thorn or spur. With this disease, a person experiences pain in the heel when stepping on, the back heel hurts more.

Common root causes of heel spur:

• flat feet;
• Excessive stress on the lower body;
• complication of joint diseases;
• Chronic foot injury.

If the foot hurts after a careless fall to the feet, discomfort is felt in the side of the heel, or there is pain above the heel behind, the person may have a stress fracture of the calcaneus. This is a serious injury, accompanied by unbearable pain, crunching in the foot, and swelling. With a stress fracture, the victim cannot stand on the foot, because it is very painful.

Damage to the Achilles tendon also causes unpleasant discomfort in the back of the foot.The Achilles tendon is located just above the calcaneus and connects it to the muscles in the back of the lower leg. It is quite strong and can withstand a tensile load weighing up to four hundred kilograms.

More often than others, this tendon is damaged by athletes engaged in:

• fast run;
• tennis;
• basketball;
• football, etc.

Adults or children who have just started active sports and have not yet learned how to properly distribute the load can get injured.in medicine, there are 2 states of damaged Achilles:

• Tendinitis. A pathological process of an inflammatory nature, which occurs against the background of microtrauma and micro-tears of tendon tissues.
• Tendinosis. It develops as a result of untreated tendonitis. With this disease, the depletion of Achilles fibers occurs.

With inflammation of the Achilles tendon, the heel hurts more from the back, redness and swelling of the ankle is also observed. If you do not ignore the pathological signs, the disease in the initial stages can be cured by conservative methods.In advanced cases, Achilles can partially or completely break away from the calcaneus, so surgical treatment is indispensable here.

Calcaneal bursitis, in which an inflammatory complication progresses in the synovial bursa, is also accompanied by aching pains in the back of the foot. In the medical dictionary, there is another meaning of the word bursa – bursa. In total, there are three burs in the foot:

• at the point of attachment of the Achilles tendon to the calcaneus;
• between the heel bone and the plantar part of the foot;
• between Achilles and soft tissues.

If untreated, inflammation of any of the three bursae leads to suppuration and the development of serious complications.

Why do heels hurt in the morning, after sleep? At the initial stage of development, heel bursitis causes aching pain in the heel. The heel area swells, turns red, becomes hot to the touch. If a purulent process has joined, other symptoms develop:

• temperature rise;
• weakness, lethargy;
• intoxication.

Causes of calcaneal bursitis:

• excessive physical activity;
• overweight;
• unsuitable footwear;
• foot injuries;
• chronic infectious foci.

If a person has a side heel pain, it is possible that the root cause of this discomfort is tarsal tunnel syndrome, which occurs due to a pinched calcaneal nerve. With such a violation, the pain does not go away even at rest. But the pain in the soft tissues of the heel can be a consequence of the heel cushion syndrome. This is an inflammation of the subcutaneous fat layer on the heel pad, which occurs for the following reasons:

• overload while running;
• inaccurate landing when jumping from a height;
• violation of metabolic processes.

What to do if heels hurt

If a person has a heel pain, what to do in this case? First of all, it is necessary to exclude provoking factors:

• heavy physical activity;
• uncomfortable shoes;
• grueling workout.

It is advisable not to overload the legs, rest more, completely eliminate heels, preferring comfortable or orthopedic shoes. To alleviate the condition and relieve discomfort, a cold compress can be applied to the sore spot.In the case when a person cannot fall asleep due to pain, to relieve the symptom, you can drink a drug of the non-steroidal anti-inflammatory group. If in the morning the condition has not improved, but, on the contrary, it has become worse, it is necessary to urgently go to the doctor. After a comprehensive diagnosis, the doctor will explain why the heels hurt and prescribe the necessary treatment.

When you need to see a doctor as soon as possible

It is not recommended to hesitate with a visit to the doctor if the patient progresses such pathological symptoms:

• Redness of the skin in the heel area.Hyperemia and a local increase in temperature indicate the development of an inflammatory process. Sometimes untimely relief of inflammation becomes the cause of suppuration and the spread of the pathological process to healthy tissues.
• Ankle edema. Puffiness is also a characteristic symptom of inflammation and may also indicate soft tissue damage.
• Problems with flexion-extension of the fingers. This symptom may indicate a tendon injury or a pinched calcaneal nerve.
• Distribution of pain syndrome to the entire foot, knee. This is an alarming sign, the reasons for which can be varied: tendon rupture, inflammation and suppuration of the soft tissues of the foot, swelling.

It is necessary to see a doctor as soon as possible if it is difficult for a person to stand on the heel and walk in general, while the pain syndrome does not decrease after reducing the load and at rest.

Which doctor should I contact

When the heel hurts badly and treatment needs to be started urgently, you must first visit an orthopedic traumatologist.During the initial examination, the specialist will collect anamnesis, ask about disturbing symptoms, and feel the affected area. However, examination alone is not enough to determine an accurate diagnosis. To find out the causes of pain and discomfort in the heel region, a referral is given for an additional diagnostic examination, consisting of the following procedures:

• radiography;
• Ultrasound of the ankle;
• CT or MRI of the problem area.

If necessary, an orthopedist-traumatologist can refer you for consultation to other specialized specialists:

• rheumatologist;
• neurologist;
• infectious disease specialist;
• endocrinologist;
• nutritionist;
• surgeon;
• oncologist.

After the final diagnosis becomes known, a specialist or a council of doctors will select an individual treatment aimed at eliminating the root cause of the pathology and concomitant symptoms.

Traditional Medicine Tips

If the heel hurts, advice on how to treat heel pain at home can only be used after coordinating all the nuances with the doctor. Self-medication is fraught with serious consequences, because discomfort in the back of the foot can be a symptom of severe pathology, sometimes requiring immediate surgical intervention.

But if the diagnosis is not complicated and conservative treatment is prescribed, alternative methods can be used as an auxiliary therapy that will help alleviate health, relieve inflammation, and accelerate recovery.

If your heels hurt and bake, what should you do at home? First of all, it is necessary to ensure the rest of the legs, trying to step less on the sore spot. If the back of the foot is swollen and reddened, cool herbal baths will help relieve these unpleasant symptoms.The recipe for such a folk remedy is simple:

1. Combine herbs in equal proportions: chamomile, sage, plantain.
2. Boil 2 liters of water, then add 4 tablespoons of the herbal mixture.
3. Remove heat, cover pan and simmer for another 7 to 10 minutes.
4. Strain the finished broth, cool to room temperature.
5. Take a bath for pain in the heels 2 – 3 times a day.

If you urgently need to stop inflammation and pain, you can apply a piece of ice to the affected area for 10 minutes.Then rest for 15 minutes and warm your foot with a heating pad. If the pain is acute, rubbing the heels with ice, alternating with thermal treatments, will help. Warming up can be done with sea salt heated in a frying pan, placed in a cloth bag.

A bath of iodine and salt has a good therapeutic effect:

1. Add 3-4 tablespoons of salt and 50 drops of iodine to warm water.
2. Stir the ingredients with honey so that the salt crystals are completely dissolved.
3. Dip your feet into the solution, take a bath until the water has completely cooled.

At the end of the procedure, wipe the feet dry and put on woolen socks.

Iodine and salt have a pronounced antiseptic effect, eliminate inflammation, relieve swelling, reduce pain and discomfort.

In case of acute inflammation of the soft tissues of the heel area, clay applications have proven themselves well, which should be used every day after hygienic procedures.Method of use:

1. Dilute a package of pharmacy clay with boiled water cooled to room temperature.
2. You should get a soft plastic mass in consistency reminiscent of thick sour cream.
3. Put plastic bags on your feet and pour dissolved clay into each portion.
4. Distribute the mass over the entire foot, securely fix the bag, and put on warm socks on top.
5. Keep the product for 15 – 20 minutes.
6. Then rinse your feet with clean warm, wipe dry and grease with nourishing cream.

Preventive measures

To prevent the development of dangerous diseases of the musculoskeletal system and avoid severe pain in the heel, it is recommended to follow these simple rules of prevention:

• Control weight, if necessary, go on a light diet to normalize body weight.
• In case of deformity of the foot or flat feet, wear special orthopedic shoes that evenly distribute the load on the lower extremities.
• Avoid injury and damage.
• When playing sports, review the level of physical activity in conjunction with a doctor and a trainer, focus on those exercises that will not harm the foot and heel.
• Perform special exercises daily to maintain the tone of all muscle groups involved in walking.
• Monitor nutrition, diversify the diet with healthy food rich in vitamins, micro- and macroelements.
• Eliminate bad habits, lead a healthy lifestyle.
• Timely treat foci of infection and prevent them from becoming chronic.
• Maintain immunity, temper.

As a preventive measure, visit an orthopedic doctor at least once a year. If a disease develops in the body that affects the musculoskeletal system, the doctor will be able to diagnose it in the early stages and successfully cure it, preventing serious complications.

What shoes to wear

If it hurts to step on the heels, it is necessary to wear orthopedic shoes, which will reduce static and shock loads on the foot, protecting the diseased area from additional injury.Prosthetic models must meet the following requirements:

• be made from natural materials;
• have a stable low heel and a dense heel with a vertical axis;
• medium stiffness, lightweight, non-slip;
• the heel area of ​​the insoles should be thickened, to cushion the foot when walking;
• the presence of an instep support.

Before buying orthopedic shoes, you need to try them on, listen to the sensations.If the model is comfortable, convenient, you can safely buy and wear it, taking care of your health and preventing the development of unpleasant complications.

90,000 heel pain when walking, symptoms, causes, treatment and prevention of heel spur ORTEKA

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m.Moscow, Prospect Mira, 211, building 2

m.Schelkovskaya

ORTEKA MSK Schelkovskaya Uralskaya 1

m.Moscow, st. Uralskaya, 1

ORTEKA MSK Shchukinskaya Marshal Vasilevsky 15

Moscow, Marshal Vasilevsky st., 15

m.Marxist

ORTEKA Marxist

Moscow, st. Marksistskaya, building 1, building 1

m.Mayakovskaya

ORTEKA Mayakovskaya

st. 3rd Tverskaya-Yamskaya, 15/14

m.Medvedkovo

ORTEKA Medvedkovo

Moscow, st. Grekova, 10

m.Mendeleevskaya

ORTEKA Mendeleevskaya

st. Novoslobodskaya, 33

m.Voikovskaya

ORTEKA Metropolis

Moscow, Leningradskoe shosse, 16 A, building 4

m.Mitino

ORTEKA Mitino

st. Dubravnaya, 35

m.Ramenki

ORTEKA Michurinsky

Michurinsky prospect, 20

m.Youth

ORTEKA Youth

st. Yartsevskaya, 32

m.Babushkinskaya

ORTEKA Moscow Babushkinskaya Yeniseiskaya 17

Moscow, st. Eniseyskaya, 17, building 1

ORTEKA Moscow Zhulebino Aircraft designer Mil 8

Moscow, Aviakonstruktora Mil str., 8, building 1

m.Sokolniki

ORTEKA Moscow Sokolniki

Moscow, st. Stromynka, 1

m.Salaryevo

ORTEKA Moscow TC Salaris

Moscow, settlement Moskovsky, Kievskoe highway, 23rd km, 1

m.Academician Yangel Street

ORTEKA Moscow Academician Yangel Street

Moscow st. Academician Yangel, 2

m.Novogireevo

ORTEKA Novogireevo

Zeleny prospect, 79A

m.Novokosino

ORTEKA Novokosino

st. Novokosinskaya, 35

m.Novokuznetskaya

ORTEKA Novokuznetskaya

Moscow, st. Pyatnitskaya, 31/2, building 5

m.October field

ORTEKA October field

st. People’s Militia, 45

m.Otradnoe

ORTEKA Otradnoe

Dekabristov street, 22

m.Pervomayskaya

ORTEKA Pervomayskaya

Russia, Moscow, Pervomayskaya street, 77

m.Preobrazhenskaya Square

ORTEKA Preobrazhenskaya Square

st. Bolshaya Cherkizovskaya, 5 bldg. 1

m.1905 Goda Street

ORTEKA Presnensky Val

st. Presnensky Val, 4, bldg. 29

m.Vernadsky Avenue

ORTEKA Vernadsky Avenue

Moscow, st. Udaltsova, 71, building 3

m.Trade union

ORTEKA Trade union

st. Profsoyuznaya, 15

m.Ryazansky prospect

ORTEKA Ryazansky prospect

Moscow Ryazansky prospect 40/2

m.Semyonovskaya

ORTEKA Semenovskaya

Shcherbakovskaya street, 3

m.Skobelevskaya Street

ORTEKA Skobelevskaya

st. Skobelevskaya, 4

m.Slavyansky Boulevard

ORTEKA Slavyansky Boulevard

Moscow, Slavyansky blvd, 5 building 1

m.Falcon

ORTEKA Sokol 2

Leningradskiy prospect, 74, bldg. 1

m.Falcon

ORTEKA Sokol 3

Moscow, Leningradsky prospect, 75, building 1A

m.Taganskaya

ORTEKA Taganskaya

st. Bolshie Kamenshiki, 3, bldg. 3

m.Okhotny Ryad

ORTEKA Tverskaya

Moscow, st. Tverskaya, 9

m.Tyoply Stan

ORTEKA Teply Stan

Moscow, Novoyasenevsky prospect, d1k2

m.Timiryazevskaya

ORTEKA Timiryazevskaya

Moscow, st. Yablochkova, 16

m.University

ORTEKA University

Moscow, Lomonosovsky prospect, 23

m.Tsvetnoy Boulevard

ORTEKA Tsvetnoy Boulevard

st. Sadovo-Samotechnaya, 24/27

m.South

ORTEKA South

Sumska st., 2/12

Foot, heel hurts

The foot, like the hand, has a complex structure.It is formed by 26 different bones,

which are connected by numerous joints and ligaments. The bones of the foot provide

mitigation of sharp loads on the joints of the legs, pelvis due to the presence of a vault. The complexity of the structure and

constant load creates conditions for the development of various diseases of the joints, ligaments,

bones of the foot. Hypothermia of the legs, sports and household injuries, other factors

increased load can cause discomfort and pain in the area of ​​the foot and heel.

One of the common causes of foot pain is trauma. Contusion, dislocation of the joint, fracture of the bones of the foot

cause severe pain, limitation of movement, swelling of the foot. In such cases, referring to

we are not late to the doctor. But there are many other causes of pain that are not initially

seem so meaningful. Foot pain can develop gradually, almost imperceptibly with

flat feet, osteoporosis, gout, rheumatoid arthritis.Varicose veins disease, phlebitis,

obliterating endarteritis can cause pain in the legs at an early and later stage.

Tolerable pain becomes constant and acute over time, can significantly limit

the ability to move.

Often the pain is localized in the heel area. The so-called “heel spur”, “plantar

fasciitis “occur more often against the background of flat feet.Flattening of the arch of the foot and overexertion

the plantar fascia, which is attached to the calcaneus, irritates both the

fascia and calcaneus, pain in the heel appears. Over time, when walking, pain in

heel are exacerbated by the developing “heel spur”. Heel spur treatment requires

time and patience.

At the Eleos clinic, qualified specialists will diagnose the cause of pain in

the foot and heel, effective treatment will be prescribed.