Heel pain is most often caused by plantar fasciitis.  The plantar fascia is a thick band of tissue that runs from the plantar aspect of the calcaneus (heel bone) to the base of the toes.  It’s job is to help maintain the arch during weightbearing activities.  Plantar fasciitis involves inflammation of the plantar fascia, most typically noted to the plantar aspect of the heel.  This typically causes pain, swelling, and limitation of activities.

Causes

Plantar fasciitis is most commonly caused by increased stress along the plantar fascia, causing micro tearing of the plantar fascia itself or at its insertion on the calcaneus (heel bone).  There are many etiologies that can cause this, including:

  • Increase in activities / overuse
  • Trauma
  • Change in shoe gear
  • Weight gain
  • Tight calf muscles

Diagnosis

Diagnosis of plantar fasciitis includes a thorough review of your medical history and clinical examination of the foot, ankle, and lower leg.  Other causes of heel pain are also ruled out, including:  stress fracture, tendonitis, arthritis, nerve irritation, space-occupying mass.

X-rays are commonly obtained to evaluate your foot structure, determine the presence or absence of a heel spur and/or arthritis, as well as to rule out potential for a stress fracture.

Non-Surgical Treatment

Treatment of plantar fasciitis primarily begins with a focus on decreasing stress along the plantar fascia:

  • Stretching exercises
  • Shoe gear modifications
  • Limitation of activities

Other treatment modalities may be necessary if the pain and inflammation are more significant:

  • Injection therapy (most common)
  • Strapping / taping, padding
  • Orthotics
  • Immobilization in a walking boot
  • Night splint
  • Physical therapy / Shockwave therapy

Is surgery necessary?

Most cases of plantar fasciitis respond well to nonsurgical treatment.  Surgery may be considered after exhaustion of all nonsurgical treatment modalities.  This involves release of a portion of the plantar fascia so that it is no longer tight, allowing you to return to activities without significant limitation and/or pain.