Heel Pain

Dr. Santoro’s advice for sufferers of heel pain:

The most common cause of heel pain is plantar fasciitis. This is an inflammation of a ligament on the sole of the foot at its insertion on the bottom of the heel bone. Plantar means bottom of the foot, and fasciitis means an inflamed layer of soft tissue.

A side view of the bones of the foot appears like a bridge or arch with the plantar fascia spanning from the heel to toes. Stress on the arch causes the foot to lengthen and lower. This puts stress on the lantar fascia, mostly at its insertion on the heel, causing it to slowly tear away from the bone, producing micro fractures in the bone’s cortex. This results in inflammation and pain. The pain is usually worse with initial weight bearing because the arch is higher when the foot is at rest. The small muscles in the foot contract. When weight bearing occurs the arch reduces causing these muscles to pull on the plantar fascia. After a few steps the arch stretches out and the pain retreats. With continued standing and walking the ligament tears more and the pain, increases again. With time, the bone repairs itself by depositing more bone, thus creating a spur. The spur itself is not the cause of pain and therefore need not be removed in most cases.

Plantar fasciitis is most common in people with high arches but is also seen in runners or walkers, people in a standing job, or those with a very flexible pronated foot. Going barefooted, wearing slippers or poorly supported shoes are all big contributors to this problem. The goals of treatment are to support the arch, to take the stress off the ligament, and to reduce the inflammation. There are many ways to achieve this. Most of the time, reduction of inflammation without arch support will provide only temporary relief at best.

Simply wearing a more supportive shoe, not going barefooted or throwing away the bedroom slippers can many times achieve adequate arch support.

The runner’s stretch helps to take stress off of the ligament by lengthening the calf muscle. An orthosis, a rigid or semi rigid device made to support the arch can provide added relief. In some cases, a splint worn at night to stretch the calf can provide added relief.

Oral anti-inflammatory agents provide little relief for this problem at best. More effective is a regime of heat, massage, and ice performed once or twice daily. This regime involves applying heat to the foot to loosen soft issues either by heating pad, warm soaks or shower for about 5 to 10 minutes. This is followed by about 5 minutes of deep massage to stretch tissues by rolling the heel and arch over a baseball or golf ball. Finally to reduce edema and pain, the heel only is soaked in a small container of ice water for about 3 or 4 minutes or until the heal becomes numb. Ice packs or frozen peas are less
effective. The most effective anti-inflammatory treatment is cortisone injection. This usually is not attempted until orthoses are implemented. While the side effects of cortisone given locally are minimal, the standard is to not give more than three injections into the same area within 12 told 18 months. Cortisone has a more lasting effect when used in conjunction with the other modalities mentioned above.

I see more heel pain than any other problem in my practice, yet I operate on it the least. Surgery is reserved for those who fail to respond to the above treatments. It is a relatively simple procedure with an average recovery time of 4 to 12 weeks, and is followed up with a return to supportive shoes and orthoses.

One last word of warning and encouragement; plantar fasciitis can be a very frustrating ailment fraught with intermittent periods of pain and remission. It can get bad enough to result in a stress fracture of the heel bone requiring an entirely different treatment regimen. However, almost everyone with the problem will get better and should be able to return to their regular activities with time, provided they allow themselves a chance to heal and follow the appropriate precautions to prevent recurrence.