Heel pain is the most common musculoskeletal complaint of patients presenting to podiatric practitioners throughout the country. It is well-recognized that subcalcaneal pain syndrome, commonly
attributed to plantar fascitis, is a disease entity that is increasing in its incidence, owing partly to the fact that it has a predilection for people between the age of 40 and 60, the largest age
segment in our population.
Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension on that bowstring becomes too great, it can create small tears in
the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.
Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But
your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time. If you have foot pain at night, you may have a different problem, such as
arthritis , or a nerve problem such as tarsal tunnel syndrome.
After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch, an area of maximum tenderness on the bottom of your
foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion
of your ankle. Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in
ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not
routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.
Non Surgical Treatment
Shoe therapy, finding and wearing shoes that allow your feet to be in their natural position, is the most important treatment for plantar fasciosis. Shoes that possess a flat heel, are wide in the
toe box, lack toe spring, and have flexible soles are most appropriate for this foot problem. An increasing number of shoe companies are producing shoes with these design characteristics, but shoes
that include all these features are still difficult to find. For some suggested footwear models, see our clinicâs shoe list. Most conventional footwear can be modified by stretching the shoeâs
upper, stretching out the toe spring, removing the shoeâs liner, and cutting the shoe at certain key points to allow more room for your foot. Visit your podiatrist to help you with these shoe
modifications. Correct Toes is another helpful conservative treatment method for plantar fasciosis. Correct Toes addresses the root cause of your plantar fasciosis by properly aligning your big toe
and reducing the tension created by your abductor hallucis longus on the blood vessels that feed and "cleanse" the tissues of your plantar fascia. Your plantar fasciosis-related pain will diminish
when the dead tissue is washed away. A rehabilitation program, which includes targeted stretches and other exercises, for your foot may be helpful too. Dietary changes and aerobic exercise are
particularly important for overweight individuals who have plantar fasciosis. Water aerobics may be most appropriate for those individuals whose pain does not allow them to walk or cycle. Physical
therapy may be another helpful treatment modality for this problem, and includes ultrasound, electrical stimulation, contrast baths, and range-of-motion exercises. Massage, acupuncture, reflexology,
and magnet therapy are holistic approaches that may be helpful.
In cases that do not respond to any conservative treatment, surgical release of the plantar fascia may be considered. Plantar fasciotomy may be performed using open, endoscopic or radiofrequency
lesioning techniques. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. Potential risk factors include flattening of the longitudinal arch and heel
hypoesthesia as well as the potential complications associated with rupture of the plantar fascia and complications related to anesthesia.
The following steps will help prevent plantar fasciitis or help keep the condition from getting worse if you already have it. Take care of your feet. Wear shoes with good arch support and heel
cushioning. If your work requires you to stand on hard surfaces, stand on a thick rubber mat to reduce stress on your feet. Do exercises to stretch the Achilles tendon at the back of the heel. This
is especially important before sports, but it is helpful for non-athletes as well. Ask your doctor about recommendations for a stretching routine. Stay at a healthy weight for your height. Establish
good exercise habits. Increase your exercise levels gradually, and wear supportive shoes. If you run, alternate running with other sports that will not cause heel pain. Put on supportive shoes as
soon as you get out of bed. Going barefoot or wearing slippers puts stress on your feet. If you feel that work activities caused your heel pain, ask your human resources department for information
about different ways of doing your job that will not make your heel pain worse. If you are involved in sports, you may want to consult a sports training specialist for training and conditioning
programs to prevent plantar fasciitis from recurring.