Heel Pain (Plantar Fasciitis)

The heel can be painful, red, and/or swollen. The first steps out of bed or after a period of prolonged rest are very painful. Sometimes it is described as a sharp, knife-like pain in the heel with that first step in the morning. The pain improves but does not go away after those first few steps. At the end of the day, after prolonged standing or walking, the pain can get worse. This can occur in one foot or both feet.

X-Rays are taken to evaluate the heel bone for a spur and to rule out other pathology such as fractures.

• Ultrasound can be used as needed to assess the thickness of the plantar
  fascia and assess for any plantar fascia tears.
• Clinical examination will be done to assess the heel, foot, and also the
  achilles tendon which plays a significant role in the inflammation of the
  plantar fascia.
• Gait exam to evaluate and address the underlying biomechanical problems.

• Strapping
• Stretching
• Corticosteroid injection(s)
• Oral anti-inflammatory medication
• Shoe gear change/modifications
• Custom Orthotics
• Night Splints
• Immobilization with a cast or a walking cast boot
• Shock Wave Therapy (SWT)
• Physical Therapy
• Surgery (Plantar Fasciotomy- endoscopic or open)

Plantar Fasciitis can become a chronic condition if left untreated. It is important to seek care when the symptoms first appears and to address the underlying cause rather than waiting for it to become worse.

As children go through “growth spurts” between the age of 11 and 14, the muscles and tendons in their legs can become tight as they try to keep up with the rapid growth in the long bones. Heel pain in children typically is the result of a tight Achilles tendon.
In children, there is a thin irregular shaped band of cartilage in the back portion of the heel bone called a growth plate (see x-ray image below). As the name implies, new bone forms within a growth plate, which is also found in other bones in the feet, legs, hands and arms.

As a child goes through a “growth spurt,” the rapidly elongating leg bones stretch the Achilles tendon which in turn pulls tighter on its insertion into the heel bone. A tight tendon is usually not a problem. However, when a child is very active in sports, such as soccer, or basketball, the increased activity creates further tightening of the tendon. The result is a traction or pulling force which is absorbed into the heel bone.

As cartilage is softer than bone, the growth plate frequently becomes irritated and painful as the traction force increases. This process is more commonly seen between the age of 8 and 13 years old and is called Sever’s disease.

On examination, one can reproduce pain by pressing both under the heel as well as compressing the heel bone (calcaneus) from side to side. Other causes of heel pain include a fracture or bone tumor, so X-rays are usually performed in evaluating this condition.

Initial treatment includes rest, ice, and anti-inflammatory medication. An arch support and heel lift are both helpful. For severe cases, a non-weight bearing splint or cast may be applied. Long term treatment usually includes use of functional foot orthotics. The problem is self-limiting and goes away after the growth plate closes, around the age of 13 to 14 years old.

Plantar Fasciitis is one of the most common causes of heel pain. The plantar fascia is a ligament that supports the arch of the foot. Plantar fasciitis occurs when this ligament gets over stressed, damaged and inflamed.

Causes

Some common causes of heel pain / plantar fasciitis include, but not limited to:

• Weight gain
• Excessive physical activity
• Abnormal (gait) walking pattern
• Improper or ill-fitting shoes
• High impact activities (i.e. repetitive jumping, certain sports like tennis,
  basketball and certain exercise programs)
• Tight calf muscles and achilles tendon

Presentation (Symptoms)

The heel can be painful, red, and/or swollen. The first steps out of bed or after a period of prolonged rest are very painful. Sometimes it is described as a sharp, knife-like pain in the heel with that first step in the morning. The pain improves but does not go away after those first few steps. At the end of the day, after prolonged standing or walking, the pain can get worse. This can occur in one foot or both feet.

Diagnosis

• X-Rays are taken to evaluate the heel bone for a spur and to rule out other
  pathology such as fractures.
• Ultrasound can be used as needed to assess the thickness of the plantar
  fascia and assess for any plantar fascia tears.
• Clinical examination will be done to assess the heel, foot, and also the
  achilles tendon which plays a significant role in the inflammation of the
  plantar fascia.
• Gait exam to evaluate and address the underlying biomechanical problems.

Treatment

• Strapping
• Stretching
• Corticosteroid injection(s)
• Oral anti-inflammatory medication
• Shoe gear change/modifications
• Custom Orthotics
• Night Splints
• Immobilization with a cast or a walking cast boot
• Extracorporeal Shock Wave Therapy (ESWT)
• Physical Therapy

Plantar Fasciitis can become a chronic condition if not treated. It is important to seek care when the problem first appears and to address the underlying cause rather than waiting for it to become worse. If you have any further questions, please do not hesitate to call The Foot and Ankle Clinic of Albuquerque, P.C.