Jeffrey R. Carlson, MD
I often see patients who are convinced that they have a huge bone spur in their heel due to the pain they experience when walking. Because the pain is often described as sharp or stabbing, they believe that a bone become dislodged or that a pointy bone growth is causing the problem. They are often amazed when they learn they simply have an inflamed band of tissue, called plantar fasciitis, causing the pain.
The plantar fascia is a band of tissue that connects the bone of the heel to the toes, supports the arch of the foot and acts as a shock absorber when walking or running. When repeatedly stretched, it can become damaged, torn, and inflamed and is the most common source of heel pain. People between the ages of 40 and 60, those who are overweight and those who walk or stand on hard surfaces for several hours at a time are at a higher risk of developing this condition. Being flat-footed, walking abnormally, or having a high arch can also increase your risk.
The symptom of plantar fasciitis is a stabbing pain in the heel of the foot. This pain is often worse for the first few steps taken after waking up and lessens greatly thereafter. If left untreated, plantar fasciitis can result in chronic heel pain and can even affect your ability to complete everyday activities. A person suffering from plantar fasciitis may alter the way they walk in order to reduce the pain. However, doing this can cause the patient to develop pain in other parts of the body such as the foot, hip, knee, or back.
This condition is diagnosed by an orthopaedic physician with a physical examination, locating the tender areas on the heel and asking questions of the patient. Occasionally, an X-ray or MRI is taken to ensure the cause of pain is not a result of a pinched nerve or a fractured bone.
Conservative treatment options for plantar fasciitis include oral anti-inflammatory medication or corticosteroid injections, OTC pain relievers, such as Aleve or Ibuprofen, physical therapy, Orthotics or a night splint. It is very important that the patient gently stretch their plantar fascia and Achilles tendon multiple times a day.
Surgery is rarely necessary to correct plantar fasciitis. In the circumstance it is required, the plantar fascia is released by few incisions into the fascia to relieve tension or can be detached altogether from the heel bone in an endoscopic outpatient surgery. If the fascia is very damaged, a small portion may be removed to allow for better healing. Bone surfaces will be smoothed and any bone spurs removed during the procedure.
Endoscopic (performing surgery using a camera and through several small incisions) surgery allows for much faster recovery than an open procedure (one large incision). Endoscopic surgery allows for immediate limited weight-bearing and a recovery time of about 2-3 weeks. Open surgery may require that the patient wear a CAM boot to aid in healing and recovery is typically 3-4 weeks. Physical Therapy may be ordered to help the patient regain range of motion, strength and flexibility. Jumping and running will be off-limits for about 3 months.
As with almost anything, prevention of plantar fasciitis is the better choice. Maintain a healthy weight, wear proper shoes with arch support, and avoid walking barefoot on hard surfaces. Ensure that shoes worn for exercising are in good condition and replace them after about 500 miles of use. Stretching the arch of the foot, as well as choosing a low-impact sport (swimming or bicycling) as opposed to a high-impact sport (running) can also reduce the risk of developing plantar fasciitis.