Heel pain is most commonly caused by plantar fasciitis, which is the swelling of the tissue that connects the heel bone to the toes at the bottom part of the foot, also known as the plantar fascia. Plantar fasciitis is often described as sharp pain in the middle of the heel, which is typically worse after periods of rest when fascia contracts. The pain usually becomes more bearable as the muscles loosen up during the low-impact walking, but can return even worse after extended periods of walking or standing. The plantar fascia serves as a shock absorber and supports the foot’s arch. Too much tension on the plantar fascia can cause inflammation and swelling. Fortunately in most cases, plantar fasciitis treatment is fairly conservative. Plantar fasciitis exercises, medications and orthotics are usually all that’s needed to manage the pain. Most severe cases may require surgery.
A number of factors can contribute to plantar fasciitis. While men can get plantar fasciitis, it is more common in women. You're also more likely to have this condition as you age or if you are overweight. Take up a new form of exercise or suddenly increase the intensity of your exercise. Are on your feet for several hours each day. Have other medical conditions such as rheumatoid arthritis or lupus (systemic lupus erythematosus). Tend to wear high-heeled shoes, and then switch abruptly to flat shoes. Wear shoes that are worn out with weak arch supports and thin soles. Have flat feet or an unusually high arch. Have legs of uneven lengths or an abnormal walk or foot position. Have tight achilles tendons, or ‘heel cords’.
Among the symptoms for Plantar Fasciitis is pain usually felt on the underside of the heel, often most intense with the first steps after getting out of bed in the morning. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity. Plantar Fasciitis also called “policeman’s heel” is presented by a sharp stabbing pain at the bottom or front of the heel bone. In most cases, heel pain is more severe following periods of inactivity when getting up and then subsides, turning into a dull ache.
Plantar fasciitis is one of many conditions causing "heel pain". Some other possible causes include nerve compression either in the foot or in the back, stress fracture of the calcaneus, and loss of the fatty tissue pad under the heel. Plantar fasciitis can be distinguished from these and other conditions based on a history and examination done by a physician. It should be noted that heel spurs are often inappropriately thought to be the sole cause of heel pain. In fact, heel spurs are common and are nothing more than the bone's response to traction or pulling-type forces from the plantar fascia and other muscles in the foot where they attach to the heel bone. They are commonly present in patients without pain, and frequently absent from those who have pain. It is the rare patient who has a truly enlarged and problematic spur requiring surgery.
Non Surgical Treatment
A change to properly fitting, appropriate shoes may be useful in some patients. Some individuals wear shoes that are too small, which can exacerbate many types of foot pain. Patients often find that wearing shoes with thicker, well-cushioned midsoles, usually made of a material like high-density ethylene vinyl acetate (such as is found in many running shoes), decreases the pain associated with long periods of walking or standing. Studies have shown that with age, running shoes lose a significant portion of their shock absorption. Thus, simply getting a new pair of shoes may be helpful in decreasing pain. For individuals with flat feet, motion control shoes or shoes with better longitudinal arch support may decrease the pain associated with long periods of walking or standing. Motion control shoes usually have the following characteristics: a straight last, board or combination lasted construction, an external heel counter, a wider flare and extra medial support. A change in shoes was cited by 14 percent of patients with plantar fasciitis as the treatment that worked best for them.
Surgery is rarely used in the treatment of plantar fasciitis. However it may be recommended when conservative treatment has been tried for several months but does not bring adequate relief of symptoms. Surgery usually involves the partial release of the plantar fascia from the heel bone. In approximately 75% of cases symptoms are fully resolved within six months. In a small percentage of cases, symptoms may take up to 12 months to fully resolve.
Preventing plantar fasciitis is crucial. There are many choices to help prevent the occurrence of this condition, and keep it from returning. One of the most important is maintaining a healthy weight in order to reduce tension on the plantar fascia. In addition, shoes are very important, and should fit well and provide ample cushioning and support throughout the heel, arch, and ball of the foot so that weight is distributed evenly throughout the foot. Try to avoid walking barefoot on hard surfaces and replace old shoes before they wear out, especially shoes that you run or exercise in. When exercising, start off slow and ease into new routines to prevent sudden or excessive stress on tissue. Lastly, keep your calf muscles and the tissue of your feet stretched. Greater flexibility in the tissue makes them less susceptible to damage.