John’s heel didn’t hurt while he lay in bed. But those first few steps each morning were particularly painful. After five to ten minutes of walking the pain subsided, only to return with a vengeance as the day progressed. The more he walked, the more his heel hurt.
The discomfort was centered right in the middle of the heel on the bottom of his foot. Often, his arches hurt too.
With some variation, that is how patients with a heel spur, often referred to as plantar fasciitis, describe their pain. To understand what the condition is, lets first look inside the heel.
On the bottom of the foot is a strong band of tissue called the plantar fascia. The fascia helps support the arch. If the plantar fascia is stretched to an abnormal degree when walking it becomes inflamed. The patient experiences discomfort in the arch and heel that is relieved by rest.
With continued inflammation, the pH of the surrounding tissues is altered. New bone may be laid down forming a boney protrusion on the bottom of the heel, commonly referred to as a heel spur. It is important to understand that it is not the spur that causes the pain but the strain of the plantar fascia. You will never get rid of the spur but you can get rid of the pain.
The strain on the fascia is caused by mechanical problems in the feet and legs. Subtle abnormalities in the way we are built causes us to walk in ways that stresses some tissues and eventually causes problems — and pain.
Heel spurs are found in all types of feet including those with high arches and flat feet. Those with heel spurs do have some things in common. Most have tight calf muscles. Most are also either athletic or overweight — or both.
It should be remembered that heel spurs are not the only cause of heel pain. Arthritis, stress fractures, abnormal growths, infection, nerve problems and injury are just a few of the many other problems that can all cause similar symptoms and should be checked.
Treatment of plantar fasciitis is directed at both the immediate pain and its underlying mechanical cause. Taping the foot to take the strain off the arch frequently provides short term relief. This is easier to do in the winter than the summer when an athlete’s foot might be an unwanted side effect of the taping.
Heel cups and pads are sometimes helpful but arch supports are usually more helpful. For many, especially when caught early, over-the-counter arch supports are often adequate. For those who are athletically active, heavy or who have tried the over-the-counter variety and found them helpful but inadequate, laboratory made, custom orthotics cost more but are much more effective.
Physical therapy in various forms may be helpful starting with the use of ice for a few minutes at a time. Other means of physical therapy are available in a medical office. Cortisone can also be injected but should be reserved for those in either great pain or where other means of treatment have not been adequate. It is most effective when provided under the guidance of ultrasound so that the medication can be precisely placed. Iontophoresis (providing low doses of medication through the skin using a very small electrical stimulus) and therapeutic ultrasound are also often helpful.
Stretching the calf muscles is VERY important for most people with plantar fasciitis. Night splints are commonly used to maintain that stretch and are especially useful for people who experience pain on arising after rest. Occasionally, immobilization in a cast or cast boot is utilized.
Another less commonly used treatment includes high intensity shockwave. Surgery is reserved as a last resort and is rarely necessary. Thankfully, for most people, the simple means of treatment discussed above usually work.