Heel Pain: What Causes It and How Do I Treat It?

HEEL PAIN

Are you having pain in your heel during the first few steps in the morning? Has the discomfort persisted day after day? If so, you may be dealing with Plantar Fasciitis. Plantar Fasciitis and other causes of heel pain are the most common conditions podiatrists treat every year. More than 2 million Americans suffer with heel pain annually. Heel pain can come in my different forms. The most common causes include Plantar Fasciitis, heel spurs, Achilles tendinitis, and nerve entrapments. There are many ways to avoid or decrease your chance of getting heel pain. In this blog post, I’ll review all you need to know about Plantar Fasciitis, from diagnosis to treatment, to possible recurrence. The most important thing to remember is to treat heel pain as early as possible before the pain worsens or causes permanent damage.

COMMON CAUSES OF HEEL PAIN

The human foot is made of 28 bones. The heel bone, or calcaneus, is the largest bone in the foot and is crucial in the overall structure of your foot as well as the way you stand, walk, or run. There are two main soft tissue attachments to your heel bone. The Achilles tendon, which is the large cord-like tendon behind your ankle, originates from the calf muscle and inserts in the back of the heel. It is the largest and strongest tendon in your body and is responsible for lifting your heel off of the ground and pushing you forward during activity. The Achilles tendon is susceptible to injury with repetitive use or overload.
The next soft tissue attachment to your heel bone, is the Plantar Fascia. It originates from the bottom of your heel bone, and fans out across your arch and connects to each of your toes while supporting your arch. The Plantar Fascia is a thick, flat, tendinous-like structure that is vital to the shape of your foot and arch. As you stand, walk, or run, the Plantar Fascia supports your arch, and aids in the propulsive mechanism of your foot.
The Plantar Fascia along with the Achilles tendon are closely related and interconnected in the overall support and function of your foot during activity. It is common to have both an Achilles injury as well as a Plantar Fascia injury in your heel bone and it is vital to treat both problems.

Most Common Cause of Heel Pain

The most common cause of heel pain is Plantar Fasciitis. As stated, the Plantar Fascia, is a large tendinous-like structure that fans out across the entire bottom of the foot. When the arch is not supported with proper shoes or inserts, the Plantar Fascia stretches, creating micro tears, and therefore becomes inflamed and painful. The most common location for the inflammation is at the origin in the heel bone. However, you can also develop Plantar Fasciitis along the entire course of the Plantar Fascia. Common symptoms include pain in the heel during the first steps in the morning or after prolonged sitting that lessens throughout the day, pain in the heel when barefoot or wearing flat shoes, and tightness along the back and bottom of the heel.

Other Causes of Heel Pain

Other causes of heel pain include Achilles tendinitis, heel spurs, stress fractures, and nerve entrapments. There are two forms of Achilles tendinitis, non-insertional, and insertional tendinitis. Non-insertional tendinitis occurs behind the ankle joint and insertional tendinitis occurs near the heel bone where the tendon inserts. Achilles tendinitis is usually caused by a sudden increase in activity, tightening of the calf muscles, or a bone spur that rubs against the tendon and causes pain. Stress fractures of the calcaneus are not as common as Plantar Fasciitis; however, they can also occur. A stress fracture is a tiny break in the bone. Athletes, who place a great deal of repetitive stress on their heel are more susceptible to stress fractures. A change in sport, osteoporosis, or improper shoes can also increase your risk of developing stress fractures.

AN EVALUATION TO IS KEY TO DETERMINING CAUSE OF HEEL PAIN

If you are dealing with heel pain, we recommend that you make an appointment as soon as possible. During your appointment we begin by asking questions such as: When did the heel pain begin? What shoes you typically wear? What makes it better or worse? We then perform a physical exam by checking your strength, the range of motion of the joints in your foot and ankle, examine for any skin changes such as redness or bruising, and then palpate and feel the area that is most tender to help us come to a diagnosis. After this we typically get in-office x-rays of both of your feet. This will help us check for any arthritic joints, rule out a stress fracture of the calcaneus, and determine if there is a heel spur that is caused by Plantar Fasciitis. At Weil Foot and Ankle, we have ultrasound imaging at all of our locations. This is a quick, non-invasive, diagnostic exam that allows us to visualize the soft tissue structures around the heel such as the Plantar Fascia and the Achilles tendon. We check for inflammation by measuring the thickness of these structures and in return, that allows us to reach a diagnosis and offer multiple treatment options.

TREATMENT OPTIONS

If you are diagnosed with Plantar Fasciitis, there are proven and effective conservative treatment options. Treatment for Plantar Fasciitis begins with an overall assessment of the shoes that you typically wear. Flat and flexible shoes that do not support the arch will cause the Plantar Fascia to stretch and lead to Plantar Fasciitis. Shoe inserts and orthotics that give extra support to your heel and arch is also recommended. At Weil Foot and Ankle, we have over-the-counter supportive inserts that can be purchased and applied from the first appointment. We can also scan your foot for custom orthotics, which are molded to the exact shape of your foot and therefore provide support so that the arch does not collapse and cause pain in your heel(s).

Conservative Options First

As stated, Plantar Fasciitis responds well to conservative treatment. The first line of treatment begins with at home, daily stretching. Stretching of the gastrocnemius (calf muscle) and the Achilles tendon allows more flexibility of the ankle joint and the Plantar Fascia, which prevents stiffness in the morning or during the first few steps after prolonged sitting. To aid in stretching we routinely dispense a night splint. This is a soft brace that can be worn at night that keeps the Achilles tendon in a slightly stretched position. In doing so, the Plantar Fascia will be spared the sudden stress that occurs with weight bearing in the morning. Physical therapy can also be helpful in aiding and assisting in stretches as well as improving strength and balance of the lower extremity.

Custom Orthotics – A More Advanced Conservative Approach

Shoe inserts or custom orthotics are one of the mainstays in preventing and treating Plantar Fasciitis. At Weil Foot & Ankle we offer 3D digital scanning that provides a highly accurate imprint and image of your foot to produce custom orthotics. These scans are completely noninvasive and take no more than 10 minutes to perform. The goal of custom orthotics is to provide a tailor-made insert that supports your heel and arch. Depending on the level of activity, we can customize the inserts to match the support you need. In other words, custom orthotics are made different for athletes and runners vs. individuals who work in a high impact environment, vs. those who have average impact levels on their feet. The inserts are made up of four layers to ensure comfort and durability and are covered by most insurances.

Pain Laser Therapy

Several of our offices offer Pain Laser Therapy. In fact we have 2 different Laser technologies for treatment of Plantar Fasciitis. MLS Laser is a dual-waved synchronized fully robotic technology and uses specific wavelengths of infrared light that are neither hot nor cold. FX635 Laser is a Low-Level Laser Therapy (LLLT), or sometimes referred to as a “Cold Laser”. While not covered by insurance, they are FDA approved. The physicians at Weil Foot & Ankle have seen great success with our PF patients using these treatments.

EPAT

More advanced and exciting treatment modalities include EPAT, which stands for Extracorporeal Pulse Activation Therapy. This is a non-invasive, FDA approved treatment that uses low energy pressure waves that regenerate damaged tissue, enhance blood circulation, and break down adhesions and scar tissue. EPAT is performed in the exam room with no anesthesia required. After narrowing down the area of pain through the physical exam, a hand-held device is used to transmit energy through pressure waves over the affected area. Treatment consists of 3 to 5 sessions performed one week apart. There is no down time and no risk of infection or scarring with this treatment. EPAT is typically not covered by insurance, however a payment plan can be provided.

Medication Options

Plantar Fasciitis can respond well to oral and topical anti-inflammatory medications. Depending on how much pain you are in, we recommend a short course of NSAIDS. The most common NSAIDS prescribed for Plantar Fasciitis includes Naproxen, Ibuprofen, and Meloxicam. These medications are safe to take for a short period, however when taken for a prolonged time it can lead to stomach irritation or ulcers which is why we only use them for the short term. In addition, topical medication to decrease inflammation can be helpful. CBD Gel, offered through our Retail Division is also a safe and effective treatment option to decrease inflammation and pain. CBD (cannabidiol) is the second most prevalent ingredient in cannabis (marijuana) however, it does not create a “high” and exhibits no effects indicative of abuse or dependency. When applied appropriately, it has the potential to fight pain and inflammation. The CBD gel sold at our offices is produced in a CGMP and FDA registered and audited facility to ensure the highest quality standards.

Injections for Plantar Fasciitis

Injections in the area of pain can be helpful in some patients. Steroid injections have been performed for many years and some patients respond well after only one injection. However, repeat steroid injections can cause further damage and prolonged pain. For this reason, we only recommend steroid injections for patients who are in significant pain and only 2-3 injections per year. A new and exciting option for the treatment of Plantar Fasciitis is amniotic injections. This is an injection that consists of human placental tissue that is injected into the area of pain. The injection contains growth factors and extracellular matrix components which promote tissue regeneration and help repair and restore your damaged Plantar Fascia tissue. The amniotic injections that we provide are FDA approved and have low complications or risks.

Surgery – Last Resort

In severe cases of Plantar Fasciitis which are not responsive to the treatments described above, surgery may be recommended. A new and exciting surgical procedure utilizes minimally invasive technology and ultrasonic energy to remove the damaged tissue in the tendon. This is a quick outpatient procedure that is performed under local anesthesia. Using an ultrasound-guided imaging, the unhealthy and damaged tissue is identified. A small incision is then made, an ultrasonic needle is inserted in the skin, and the damaged tissue is removed while preserving healthy tissue. Due to the minimally invasive approach, this procedure has minimal downtime and a short recovery period. Patients are typically not restricted from routine activities following the procedure, and patients will start to see improvement in 4 weeks or less. In these rare cases where surgery is recommended, you can rest assured that our Weil physicians are the best around to provide your surgery.

PREVENTION OF RECURRANCE

Recurrence of Plantar Fasciitis and heel pain is possible. Patients can experience pain and discomfort again, even after initial successful treatment. Common causes for recurrence of Plantar Fasciitis include change in lifestyle, activity level, or shoes. This is especially prevalent in athletes who change their activity or training level frequently. In addition, patients who are required to do a lot of walking for work or standing for long periods of time are suspectable to chronic or recurring heel pain or Plantar Fasciitis

Shoes

Preventing Plantar Fasciitis from recurring is possible. The most important aspect in preventing Plantar Fasciitis is wearing supportive shoes along with custom orthotics and daily stretching. Shoes that are flexible around the arch and heel or shoes that do not have enough arch support will cause the arch to flatten and stretch out the Plantar Fascia causing inflammation. Especially in athletes, daily stretching can help prevent tightness around the heel and reduce strain to the Plantar Fascia. If running causes pain to reoccur, then switching to low impact exercises like a stationary bike or swimming is recommended. In addition, weight loss and a healthy lifestyle can prevent added stress to the heel.

Seeking Treatment Early

Our doctors know that the longer treatment is put off when pain due to Plantar Fasciitis has reoccurred, the more the likelihood of permanent damage to the tissues and therefore the longer it takes and harder it is to achieve healing. If your Plantar Fasciitis has returned, it’s best to call your Podiatrist right away for an appointment.

SCHEDULE WITH A PODIATRIST TODAY

At Weil Foot & Ankle, patients can rest assured that they are receiving the most competent, high-quality treatment. For more than 50 years we have been committed to improving the quality of life in a patient-focused environment by providing the most innovative and knowledgeable foot and ankle care available.

If you have a question about Heel Pain or Plantar Fasciitis, please schedule a consultation with one of our specially trained podiatrists. During your consultation, a Weil Foot & Ankle podiatrist will evaluate your concerns and determine an ideal treatment plan for your specific case.

Get started today by calling our team at 847-750-7666 or easily book an appointment online. We look forward to caring for you!