Heel Pain (Plantar Fasciitis)
Plantar fasciitis is an overuse injury of the plantar fascia of the foot, which is a thick ligament that connects the heel to the front of the foot. Specifically, this soft-tissue problem causes inflammation of the plantar fascia, which is located on the bottom (plantar side) of the foot and helps provide arch support. Plantar fasciitis is an overuse condition, which means that the heel pain it causes develops gradually over time. The heel pain symptoms from plantar fasciitis can eventually become severe enough that it can make walking difficult.
If a person puts increased pressure on their plantar fascia ligaments over time for any reason—whether due to obesity, overburdening their feet, like when training for and running in a marathon, or participating regularly in another high-impact activity that's hard on the feet—they can develop plantar fasciitis. Adults who are on their feet all day due to their jobs, even if they are wearing supportive shoes, can also develop plantar fasciitis and the heel pain that goes along with it.
Other causes of and risk factors for plantar fasciitis include foot deformities, such as having high-arched feet, as well as being flat-footed, which can also put a person at greater risk for plantar fasciitis because the plantar fascia is out of alignment, and therefore, can be more easily damaged. (Note that another type of common foot deformity, heel spurs—which form on the calcaneus, or heel bone—is not a common cause of plantar fasciitis.)
Home treatments, including anti-inflammatory medications and over-the-counter pain relievers, can support foot health, reduce symptoms of chronic heel pain, and help the plantar fascia heal. There are nonsurgical treatments available to treat this foot problem too, such as night splints, orthotics, heel cups (heel-shaped pads that go into the shoe), and extracorporeal shock wave therapy. These treatments are described in more detail below.
Initial home treatment includes elevating the feet several times a day, avoiding weight-bearing activities, and applying ice. These steps, especially when practiced all together, can aid in healing as well as help reduce heel pain associated with plantar fasciitis.
Anti-inflammatories, such as ibuprofen, can help reduce swelling and pain in the plantar fascia. Other nonsteroidal anti-inflammatory drugs, such as Aleve® (naproxen), can help you manage the pain caused by plantar fasciitis.
Nonsurgical Treatment Options
- Corticosteroid Injection: This shot is delivered directly into the damaged plantar ligament. A doctor may use an ultrasound device to help determine the best place for this steroid injection.
- Physical Therapy: One of the first steps many doctors will take is to prescribe physical therapy. A physical therapist can work with a patient to help stretch the plantar fascia and Achilles tendon and reduce heel pain.
- Night Splints and Boot Casts: Night splints hold the foot in a flexed position while you sleep and help stretch the plantar fascia and Achilles tendon. A semirigid boot cast can be worn during the day and stabilizes the foot while the plantar fasciitis heals.
- Custom Orthotics: These custom-designed shoe inserts can be prescribed by your doctor and may help prevent further damage, reduce inflammation, and relieve pain. Using over-the-counter orthotics (arch supports) can also help relieve foot pain and heel pain.
- Extracorporeal Shock Wave Therapy (ESWT): This shock wave therapy causes sound waves to pulse against the heel, which helps stimulate healing in the ligament.
Surgery for plantar fasciitis is uncommon; however, there are options if a patient is experiencing severe, chronic plantar fasciitis that is not improving with conservative treatments:
- Plantar Fasciotomy: This minimally invasive surgical procedure uses endoscopy to release the fascia, which means the plantar fascia will be partially detached from the heel bone.
- Gastrocnemius Recession: Another option for treating plantar fasciitis, this procedure lengthens the calf muscle.
Keeping You in Motion at Lakeshore Bone & Joint Institute
Our board-certified foot surgeons, Paul J. Gruszka, M.D., and Scott P. Fielder, M.D., and our specialty-trained podiatrists, Marc S. Bruell, D.P.M., Rachel L. Stern, D.P.M., Brian T. Damitz, D.P.M., Ronald E. Izynski, D.P.M., and Aaron K. Ruter, D.P.M., can diagnose and treat your plantar fasciitis. Our foot specialists also provide any follow-up care you may need. While it may be possible to treat your condition without surgery by using custom-made orthotics or a nonsurgical treatment, if surgery is required, our doctors can expertly perform the procedure that is needed.
To schedule an appointment with one of our experienced foot surgeons or podiatrists, please call (219) 921-1444 or request an appointment online.