Heel Pain – Plantar Fasciitis

Plantar fasciitis is one of the most common conditions seen in our office and is the most common reason for heel pain. There are other causes of the heel pain (stress fracture, nerve entrapment, tendonitis, arthritis, cyst) so it is important that a proper diagnosis be made from the onset.

The plantar fascia is a band of tissue that runs from the heel, spans the entire bottom of the foot, and inserts onto the forefoot. The function of the plantar fascia is to support the arch of the foot. As one walks, the plantar fascia contracts and stretches. But with certain predisposing factors such as flat feet, high arched feet, weight gain, prolonged walking, poor fitting shoes, and minor trauma, the plantar fascia may undergo extreme stress and twisting, resulting in inflammation. Plantar fasciitis is this inflammation of the plantar fascia tissue which occurs mostly at the insertion point on the heel or anywhere along the tissue.

The symptoms of plantar fasciitis usually consist of pain in the bottom of the heel, pain with prolonged walking/activity, and pain with the “first step” in the morning or after prolonged sitting that gets relieved with some walking. The reason behind the “first step” pain is that with inactivity, the plantar fascia contracts and overly tightens which then causes a severe stretch or tearing with the first steps. As one walks it off, blood flow improves to the area and the plantar fascia undergoes a therapeutic stretch.

The diagnosis is usually made with history and physical examination. We may take x-rays or an ultrasound to rule out stress fractures and nerve entrapments, which may mimic plantar fasciitis. Sometimes heel spurs may be seen on diagnostic images, but rarely is it a source of pain, contrary to most people’s beliefs.

Treatments

First Line

  • Icing (with frozen water bottle – 20 min on/ 20 min off)
  • Stretching (see back of page for stretches)
  • MLS Laser (Acute: 6 treatments, Chronic: 10 – 12 treatments)
  • Orthotics (Prefabricated (Quadrasteps), Custom Orthotics)
  • Shoegear modification (stiff soled shoes to prevent overflexion of plantar fascia)
  • NSAIDs (anti-inflammatories: OTC and Rx; e.g. Motrin, Aleve)
  • Decreasing/ Modifying Activity (avoiding jumping, jogging, or prolonged walking/ standing)
  • Amnion Injections (Umbilical Cord and Amniotic Membrane to promote healing)
  • KT Taping

Second Line

  • Cortisone Injections (reduces inflammation and pain)
  • Night splint/ Equinus brace (stretches plantar fascia)
  • Physical Therapy
  • CAMwalker (immobilization)

Third Line

  • Surgery