Joel D. Stewart, MD
As a busy foot and ankle specialist, I often see patients complaining of heel pain. Here, I’ll discuss the two most common reasons for heel pain and how they are treated.
Plantar Fasciitis – The way I hear patients describe the pain they feel from Plantar Fasciitis is pretty much the same. “I get out of bed, take a step and it feels like someone has stabbed me in my heel or like I’m stepping on a sharp rock!” The Plantar Fascia is a ligament that starts at the heel and connects near the toes. When it becomes irritated, extreme morning heel soreness usually occurs, which lessens as the patient gets up and moves around. It can be caused by obesity, flat footedness, working at a job which requires a lot of standing or wearing shoes with poor support. Athletes, particularly runners, can also be afflicted.
Achilles Tendonitis – This condition is caused by overuse of the Achilles Tendon, which connects the heel bone to the calf muscles. Pain will typically be felt in the middle of the achilles or on the side of the heel. The pain also tends to be worse upon arising from bed and improves with movement throughout the day. It is quite common in athletes, but is often seen in those with flat feet, those who have tight calf muscles, and in older persons, particularly men. Shoe choices can irritate this as well. Obesity, psoriasis, ankylosing spondylitis and high blood pressure may also contribute to this disorder. Achilles Tendonitis may make you more prone to having a tendon rupture in the future.
When you come to see me in the office for your heel pain, I’ll do a thorough physical examination, watch you walk, ask you to bend and flex your foot and calf muscles and I’ll ask you a lot of questions about your symptoms. I will order x-rays to make sure we aren’t dealing with some sort of boney issue, such as stress fractures, arthritis or bone spurs.
Both of these conditions are treated similarly. I will order a stepwise process. Often, we start with relative rest, activity modification based on your lifestyle, workout regimen and the type of work you do. I may prescribe non-steroidal anti-inflammatory medication, such as Aleve for a short period of time. Icing, taping, and bracing or splinting may be appropriate. Physical Therapy is almost always prescribed for these two conditions, as stretching and strengthening the muscles in the foot and ankle and calf will be most helpful for long term relief of the painful symptoms. As both of these conditions can become chronic, it is important that the patient be persistent, complete their physical therapy exercise program and continue to do the exercises at home for the best outcome.
If your symptoms persist, a steroid injection or oral dose pack may be necessary to tamp down the inflammation. Rarely is surgery necessary for Plantar Fasciitis. I also try to minimize it for Achilles Tendonitis. For chronic cases of Achilles Tendonitis called Tendinosis, the fibers of the tendon start to break down.
If conservative measures fail, we can discuss surgical options. There are some new treatments like platelet rich plasma(PRP), stem cell injections, or things like the Tenex procedure. If that still doesn’t work, we have different surgical options, some as invasive to taking down the Achilles and reattaching, tendon transfers, or releasing the plantar fascia. We will discuss them in detail before considering surgery. We’re here to help you get back to the activities you love with less pain.