Arlington Foot & Ankle Center

Ben Pearl, D.P.M., F.A.C.F.A.S.

N.I.H. Consultant

HEEL PAIN

If you have heel pain, you are not alone.  There are a number of causes that can contribute to this, including bursitis, neuritis, bone bruise, stress fracture and the most common ailment plantar fasciitis. Bursitis and neuritis are inflammations of the heel bursa and the nerve under the heel respectively.  Plantar fasciitis implies an inflammation of the fascia or arch at some point along the structure.  The fascia gives the bones support and originates on the bottom of the heel bone and attaches to the heads of the bones in the forefoot called metatarsals.

The term fasciitis has been challenged because no inflammatory cells have been noted in the region of the fascia on pathology examination. Magnetic resonance images which view soft tissue, have demonstrated micro tears in the fascia.

The presence of a heel spur does not necessarily mean you have plantar fasciitis.  The causes of plantar fasciitis are more straight forward.  You do not need to have a heel spur on a x-ray to have plantar fasciitis.  Very often these are incidental findings.  The main cause of plantar fasciitis is due to stress from high impact activities such as running and hiking.  Athletes that pronate (rolling their foot in excessively) or overweight individuals, are especially susceptible to this.  If you have a tight achilles tendon, this can place stress on the fascia.  Treatment for fasciitis is variable and sometimes controversial.  The time tested techniques include decreasing high impact activities, losing weight if indicated,  stretching the achilles tendon, providing support in the form of an orthotic (custom arch support) or off the shelf support, changing footwear an use of ice and anti-inflammatories.  Stretching cannot be overemphasized as the achilles tendon can be very  tight and it should be stretched several times a day.  Antiinflamatories can take two forms, those taken by mouth and  injectable form.  Both can help manage pain but are band-aids for the cause.  Physical therapy including electric stimulation and massage can be helpful. Accupuncture has been used by some with success.  A new treatment has been called extracorperal shock therapy.  This utilizes a shock wave triangulated to the area of pain and has been used with some success in very limited studies. The technology has recently been FDA approved for use in plantar fasciitis.  Because a new treatment has been approved for use does not mean it is a more  effective treatment.  Surgery is rarely indicated and when it involves release of the inner band of the fascia.  The good news is that well over 90% of plantar fasciitis responds to conservative care.

Copyright 2001, Dr. Pearl. All rights reserved.