Features April 2012 Issue

Heel Pain: Rx for Underfoot Agony

Plantar fasciitis and other causes of heel pain can be debilitating, but they respond well to simple treatments.

If you experience severe heel pain, chances are you have plantar fasciitis. 

For foot and ankle specialist Brian Donley, MD, President of the Cleveland Clinic-affiliated Lutheran Hospital and Editor-in-Chief of Arthritis Advisor, plantar fasciitis is one of the most common diagnoses in his clinic. And, this frustrating condition can linger for weeks or months.

“It can be very debilitating,” he says. “It’s almost epidemic, and it happens in all types of people.”

In most cases, plantar fasciitis and other causes of heel pain can be addressed without the need for surgery. The key is to pinpoint the source of the pain and use simple treatments to get back in step.

Plantar Pain
Heel pain generally originates in the plantar fascia, a band of tissue extending from your heel to the ball of your foot. As you age, inflammation and small tears may develop in the fascia, usually where it meets the heel bone, or calcaneus. Sometimes the pain is so intense that it affects your gait pattern, causing problems elsewhere, such as the ankle or knee.

“The way you can tell if you have plantar fasciitis is if it hurts in the morning when you first step on it, gets a little better after that, and then hurts again later in the day,” Dr. Donley says. “Another sign is startup pain, when you sit for a while and then get up to walk. Some people describe it as having an ice pick in the bottom of their foot.”

You’re more likely to develop plantar fasciitis if you’re overweight, have diabetes, high arches, flat feet, or you spend a lot of time on your feet. The condition also may develop if you fail to warm up and then overexert yourself and overstretch the plantar fascia during exercise.

Other Painful Possibilities
When you think of heel pain, you might blame it on heel spurs, bony outgrowths that are commonly associated with plantar fasciitis. However, these growths usually are not the source of the pain.

But heel pain can result from a stress fracture to the calcaneus. Unlike plantar fasciitis, pain from a calcaneal stress fracture tends to occur after you’ve walked awhile. This injury is more common in people who overtrain or run on hard surfaces, as well as in older adults with low bone mass (osteopenia) or osteoporosis.

“A stress fracture is a fatiguing of the bone, an accumulation of normal forces that end up being too much,” Dr. Donley says.

Heal Your Heels
You can usually get past a calcaneal stress fracture with rest, ice, a heel pad, and analgesic medications, Dr. Donley notes, but see your doctor to rule out osteopenia or osteoporosis.

The cornerstone of plantar fasciitis treatment is stretching, targeting the Achilles tendon. Icing and taping your heel and ankle may help. As initial treatment, Dr. Donley also recommends anti-inflammatory medications, a spongy heel cup placed in your shoe, and a night splint that stretches your Achilles tendon while you sleep.

He cautions that you don’t need to spend $300 to $400 on custom orthotic shoe inserts at the outset. Instead, continue other conservative treatments for at least six weeks before you consider custom inserts or injections of pain-relieving corticosteroid drugs.

Researchers also continue to study shock wave therapy, which uses high-energy ultrasound waves to stimulate your body’s healing response. Another option is platelet-rich-plasma injections, which deliver enriched blood directly to the area of injury to promote healing.

Only about 5 percent of patients with plantar fasciitis require surgery. And, Dr. Donley advises, “You should not consider surgery until you’ve first tried stretching exercises for at least three to six months.”