Heel pain is one of the most common problems we see patients come in for in our office. This specific article focuses on plantar fasciitis, which is the type of heel pain where you get pain on the bottom of the heel. If you are having pain in the back of the heel, it is typically caused from Achilles tendinitis or a calcaneal spur, which is a bone spur that can grow on the posterior part of the heel.
Plantar fasciitis can be a very difficult problem to deal with, because it really limits patient's ability to walk comfortably. It typically causes pain with the first step out of bed in the morning, but it also can cause pain all throughout the day on the bottom of the heel.
The pain is generated from tearing that occurs at the planter fascia origin around the calcaneus. Patients typically develop microtears within the tissue and then the body tries to heal this with inflammation, but the problem is the inflammation ends up causing more pain.
The initial home treatments that we recommend are icing the heel 20 minutes twice a day and Achilles tendon stretching exercises where ideally you stretch for at least 3, 30 holds of the stretch, 3 different times throughout the day.
The next step in treatment is shoe modification. We think people get the most benefit with plantar fasciitis when they wear stiff soled supportive shoes. Many people try to get gel type cushion inserts first, but this rarely helps plantar fasciitis because the foot needs more support. We offer both over-the-counter and custom made orthotics to help patients with this problem.
If these treatments have not worked, the next step will typically involve either injections with cortisone or stem cells or using a night splint, which is a brace to help stretch the foot and ankle further.
Unfortunately, we do see patients that still do not get better with this problem, and if they have failed conservative therapy for 6 months or more, then surgical options are available. There are some minimally invasive surgical options for plantar fasciitis, but the success rate with these seems to be a little bit lower than the open surgical procedures.
Surgical treatment for this involves lengthening the plantar fascia to stop the tearing from happening and help the pain go away. We may or may not recommend removing the calcaneal spur at the same time depending on how much it seems to be the source of the pain. The one thing that we did not use to address is tightness within the Achilles tendon during the surgeries.
More recent research has shown that a tight Achilles tendon actually causes a lot of the problems with plantar fasciitis. We now recommend doing a procedure called a gastrocnemius recession to partially lengthen the Achilles tendon to fix the tightness, which research has shown, gives a higher success rate of keeping the heel pain from coming back.
If you are suffering from heel pain or any other foot and ankle pain, we are here to help you. Call your Colorado Springs podiatrist and foot and ankle surgeon team today at 719-488-4664, so we can help keep you active and pain-free!
