Dr. Vincent Giacalone
Podiatric Medicine & Surgery
466 Hook Rd., Suite 24D, Emerson, NJ 07630
Heel pain can have many causes, however is generally the result of subtle changes in the structure and function of our feet that place too much stress on the heel bone and the ligaments attached to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear; or being overweight. Causes of heel pain also include lack of arch support, inadequate flexibility in the calf muscles, suddenly increasing activity, and spending too much time on the feet. Heel pain, which can sometimes be disabling, can occur in the front, back or bottom of the heel.
What is Plantar Fasciitis?
Plantar fasciitis (pronounced PLAN-tar fashee-EYE-tiss) is an inflammation of the ligament on the bottom of the foot called the plantar fascia. The plantar fascia helps to support the arch of the foot by acting as a bowstring that connects the ball of the foot to the heel. Due to the repetitive nature of walking, plantar fasciitis may be a repetitive stress disorder. This condition benefits greatly from rest, ice, support and periodic stretching, but may also be treated with non-steroidal anti-inflammation medication (NSAIDs), mechanical splints, orthotics and injections before considering surgery.
The classic sign of plantar fasciitis (which is often confused with or considered the same as a heel spur) is pain ranging from the heel to the arch, with the first few steps in the morning or gets worse throughout the day. The pain is usually in the front and bottom of the heel and into the arch. Patients often report that the pain “moves around” to different areas of the bottom of the foot. The pain can be mild or debilitating. It can last a few months, become permanent, or come and go with activity level. The heel or arch may hurt or the condition may become worse from the heel striking the ground, but plantar fasciitis is not caused by the heel striking the ground.
What is Heel Spur Syndrome?
Heel spur pain generally occurs on the bottom inside portion of the heel. Heel spurs grow from the bone on the bottom of the heel bone in the plantar fascia ligament near its attachment to the heel bone that result from repetitive stresses and inflammation in the plantar fascia. Heel spurs are the body’s response to injury and inflammation. Many people have heel spurs but do not have pain. Many people have heel pain without a visible “bone spur” on an x-ray. In this situation the problem is called “Heel Spur Syndrome”. A heel spur and or inflammation of the plantar fascia may “trap” or irritate nerves in the heel area and cause more pain. It is often difficult and usually unnecessary to distinguish between plantar fasciitis and heel spur syndrome. Causes and treatments (except for surgery and injections) for the two conditions are the same. Many people use the terms “heel spurs” and “plantar fasciitis” interchangeably. The phrase “heel spur” is used more often than “plantar fasciitis” because a heel spur can be seen on an x-ray and it is easier to pronounce, remember and spell than “plantar fasciitis”.
What are the Causes?
The condition is usually caused by a change or increase in activities, lack of arch support in the shoe, lack of flexibility in the calf muscles, being overweight, a sudden injury, using shoes with little cushion on hard floors or ground, using shoes that do not easily bend under the ball of the foot, or spending too much time on the feet and sometimes the cause is unknown. Heel spurs result from pressure on the muscles and ligaments of the foot, by stretching of the plantar fascia ligament and by repeated pulling away of this ligament from the heel bone. Resting provides only temporary relief. When you resume walking, particularly after a night’s sleep, there is a sudden elongation of the plantar fascia band when you first stand in the morning, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking. While injury, overuse or mechanical causes can bring on discomfort in the heel, a painful heel may also accompany a more serious condition, such as gout, arthritis, psoriasis, collagen disorders, nerve injuries, heel bone abnormalities and tumors.
What is The Treatment of Heel Pain?
If pain and other symptoms of inflammation (redness, swelling, heat) persist, you should limit normal daily activities and contact Dr. Giacalone. A clinical examination of the area along with X rays may be necessary to rule out problems of the bone and diagnose heel spur syndrome or plantar fasciitis. Early treatment might involve oral or injectable anti-inflammatory medication, stretching and shoe modifications or changes, taping or strapping, or use of shoe inserts or custom orthotic devices. Physical therapy may be used in conjunction with such treatments. A functional custom molded orthotics may be prescribed for correcting biomechanical and flat foot imbalance and supporting of the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery. However in spite of appropriate care some patients heel pain require more advanced treatments or surgery. If surgery or further treatment is necessary, it may involve shock wave treatment, the release of the plantar fascia, removal of a bursa, or removal of a neuroma or other soft-tissue growth.
What Can I Do To Treat Heel Pain At Home?
Several steps can be taken to help care for a painful heel at home. As long as you are not allergic or it is contraindicated, take medications that contain ibuprofen daily as directed, for one to two weeks to help reduce tissue inflammation. Follow dosage directions carefully. Discontinue use if any adverse reaction occurs, or if pain is not relieved after several days’ use. Soak the heel in ice water to relieve pain and inflammation. Avoid sports and other vigorous activities while healing. Wear higher heeled shoes and choose shoes with heels made from soft rubber instead of leather. Running shoes are often the most comfortable. Stretch the calf muscles daily.
What Are The Non-surgical Medical Treatments?
If self-care measures do not relieve the pain, the doctor may recommend various treatments to reduce inflammation. Some of these may include, prescription oral non-steroidal anti-inflammatory medications, cortisone injections to reduce inflammation and pain, physical therapy, orthotripsy or shock wave therapy and custom orthotics. A custom orthotic (custom-made to fit the foot) can often relieve the strain on the tissues and permit the heel to recover.
What is Orthotripsy or Shock Wave Therapy?
While not a surgical procedure (no cutting of skin or sutures) this treatment is performed in the office and requires only local anesthesia of the heel. The procedure takes 15 minutes and patients leave wearing their own shoes with no bandage or dressing. It typically requires 3 to 12 weeks for the heel pain to diminish. The success rate of this treatment is similar to that of surgery.
What Is The Surgical Treatments for Heel Pain?
If non-surgical medical treatments fail and pain persists, surgical intervention may be necessary. This procedure is performed comfortably under either local anesthesia or minimal sedation. During surgery, called endoscopic plantar fasciectomy, a small camera is used to separate a portion of the plantar fascia from the heel bone. A small incision on the inside of the heel is made and using a camera to visualize the fascia, part of it is cut using a small blade attached to the camera. One to two stitches will be required.
How Can Heel Pain Be Prevented?
Unfortunately, prevention is not always possible. If pain is related to activity or an abnormal foot structure (such as flat feet or high arches), modifying the daily routine to exclude some activities that are stressful on the feet, and the use of orthotics should be considered. For example, jogging should be replaced with biking and/or swimming. If symptoms of heel pain develop, icing the foot should begin immediately.
Dr. Giacalone has been trained specifically and extensively in the diagnosis and medical and surgical treatment of foot disorders. Dr. Giacalone has been board certified by The American Board of Podiatric Orthopedics and The American Board of Podiatric Surgery since 1993 and 1995 respectively and is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Giacalone performs surgery at Hackensack University Medical Center in Hackensack, Hackensack University Medical Center @ Pascack Valley in Westwood and Surgicare Surgical Center in Oradell.