Pain beneath the heel or arch when standing or walking is commonly referred to as heel pain or plantarfasciitis. This is a very common condition which often develops slowly and insidiously and frequently results in a progression in intensity if left untreated. Plantarfasciitis can be seen in patients experiencing a rapid weight gain, can occur following a trivial injury (such as a stone bruise), beginning a running program too aggressively, wearing flip flops or sandals for a prolonged shopping trip or walking or improper use of an inclined treadmill. Plantarfasciitis can often be seen in people showing weak structural integrity of their foot due to abnormal biomechanics. Classically the pain is worse after periods of rest, worse in the early morning or after long periods of standing or walking. The foot often shows no abnormal visual changes such as swelling, redness or elevation in skin temperature.
The plantarfascia is a strong connective tissue band which forms the base of the triangle in the foot, connecting the front of the foot (metatarsal heads) with the back of the foot (heel).
Diagnostic ultrasound is performed in the office and is a very cost effective method to directly image the plantarfascia allowing measurements to be taken at the point of insertion. The plantarfascia often becomes enlarged with inflammatory conditions such as plantarfasciitis. Ultrasound can easily confirm the continuity of the fascia and is helpful to identify any tears of the fascia or masses within the fascia. This can rapidly help rule out other causes of pain and determine the most effective treatment option for you.
Common treatment options often involve stretching exercises, night splints, heel cups, physical therapy manipulation with anti inflammatory modalities, ice and massage, oral anti-inflammatories, injectable anti- inflammatory medications such as cortisone injections, pre fab arch supports, prescription arch supports and in more resistant cases, radial shock wave therapy.
The overwhelming majority of patients completely respond to conservative, non- surgical treatments.
Some cases of heel pain are mistakenly identified and treated as plantarfasciitis when they may have a completely different etiology or cause. Some of these less common causes could include; nerve compression syndromes including tarsal tunnel syndrome or herniated spinal disc with radiculopathy; undiagnosed inflammatory arthritis, tumors of the plantarfascia, tendinopathy of the peroneus longus tendon, torn or ruptured plantarfascia, stress fracture of the heel, tumors of heel bone, just to mention a few.
- Note: It’s always wise to first consult your doctor prior to initiating any treatment or taking any medication.