Plantar fasciitis (or heel pain) is commonly traced to an inflammation on the bottom of the foot. It is caused by inflammation of the connective tissue that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Once the ligament gets weak and swollen, you will begin to feel pain on the bottom of the foot. 

heel pain
What Does Heel Pain Feel Like?

It feels like a dull ache most of the time, but when the patient first gets out of the bed in the morning, or when getting up after sitting for a period of time during the day, the pain in the heel is impressive. It almost feels like the heel has been bruised, from falling on a rock barefoot, but it is worse.

What Caused the Heel Pain?

There is a tight ligament (band of fibrous tissue) that stretches across the arch, from the ball of the foot to the heel bone, called the Plantar Fascia. When we walk, our feet have a tendency to roll inward, toward each other, in a motion that we call pronation. When feet pronate, they flatten, stretch out and the arch elongates. This causes excessive pulling on the Plantar Fascia ligament and attachment of the ligament to the heel bone begins to separate. An injury occurs where the ligament progressively tears off of the heel, fiber by fiber. Bleeding occurs next to the bone and inflammatory fluids accumulate between the ligament and the bone, forming a Bursitis, or fluid-filled sack.

Over time, the body lays down scar tissue, in an attempt to "glue" the detached ligament fibers back on to the bottom of the heel bone. Over the course of 3-5 years, the scar tissue calcifies, and this calcium deposit eventually becomes visible on X-Ray as the Heel Spur. This inflammation of this Plantar fascia ligament is called Plantar Fasciitis, and in addition to the Bursitis, is what causes the pain. 

Causes of Heel Pain

There are several reasons that this chronic injury can occur. Recent weight gain and increased activity level often start an episode. A person who has been mostly sedentary, who walks a lot at Disney World for 3 days is a prime candidate. A change of shoes from well supporting walking or athletic shoes to floppy sandals can do it. When the arch of the foot collapses or flattens, the Plantar Fascia is stretched, causing the injury where it attaches to the heel bone. Finally, conditions which cause generalized increased inflammation, like osteoarthritis or rheumatoid arthritis can cause this.

Treating Heel Pain

There are many treatment options available for heel pain. In most cases, a conservative heel pain treatment is all that's needed and recommended. Treatment such as heel pain stretches, orthotics, physical therapy, proper shoes or painless laser therapy may be enough to treat your heel pain.  If you have a severe case, surgical intervention may be required. 

heel surgery

Preventing Heel Pain

Recurrence is rare after treatment, if the patient continues to employ good mechanical foot control by continuing to wear orthotics and good supportive walking or athletic shoes. Recovery is rapid and the success rate is better than 90%.   

Peter Wishnie, D.P.M.
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Owner of Family Foot & Ankle Specialists in Piscataway and Hillsborough, NJ. Make an appointment today!