Why the Heel Hurts

There can be many causes of heel pain, but perhaps the most common one is called plantar fasciitis, or heel spur. Whatever name you call it, the way you recognize it and the way you treat it are the same. Patients always ask, “Why did this happen to me?” To answer this question, we need to understand how the bottom of the foot works as we walk or run. The plantar fascia is a tight ligament which is attached to the calcaneus, the large bone in your heel. Ligaments are like braided rope. They help hold bones in the proper line, allowing the joints to be stable and work smoothly.

The plantar fascia stretches along the whole bottom of the foot, right up to where the toes are attached. Since the foot has 26 bones, more than any other part of the body, the plantar fascia has a big job to do. Where it attaches to the heel bone, it is only about the size of a pencil, making this point a “weak link” and very attractive to injury. As you walk or run, the way the bones of your foot are lined up also influences the way the plantar fascia works. If, for some reason, the bones in your foot make the arch flatten out in order for you to balance, then the plantar fascia must help by fighting back or resisting the action of walking or running. This stretching may cause pain all along the bottom of the foot, but especially in the heel, since it is the weakest point. Your body will react to this increased stress by becoming swollen and inflamed. You may not see the swelling, but it is there all around the attachment of the fascia. This swelling causes the pain you feel. The story does not end there. Your body is still trying to get stronger to fight the stress it feels.

Because walking or running is an act you repeat over and over, the body also keeps up its part by creating bone to act as a defense. We call this bone a heel spur. By the time these spurs form, they often no longer hurt.

People describe plantar fasciitis pain as an aching tightness, or sharpness, on the bottom of their heel. Occasionally, it may feel like a nail piercing. The pain is worse when first getting out of bed in the morning or after sitting for a long time. Their first few steps are very painful. Then, as the foot warms up, the pain will start to go away. This can take just a few minutes or as much as 45 minutes. Other people say that the pain increases after they stand for a long time.

In the Beginning . . .

What makes plantar fasciitis start? The answer is any action which puts the foot under stress. The activity may be that of a runner who increased his mileage, or it may be a person who is wearing a different pair of shoes, ones that do not support, or hold up, the foot. Or, it may happen when a person gains weight, 5 to 10 pounds, quickly.

How Your Podiatrist Can Help

To help you get rid of the hurting so that it does not come back, the first thing you need to do is rest your foot for at least 48 hours. If the rest doesn’t help and you decide to visit your podiatrist, who is an expert in foot problems, there are some ways he can help you. After looking over your foot and talking with you about what happened, the doctor may want to watch you walk or run. This will give him some clues as to how your body must balance when it is moving.

Then we will take x-rays to help see inside the foot and how the bones actually line up. Sometimes we order laboratory blood tests because some illnesses, such as arthritis, may show themselves by the heel hurting.

On your first visit to our office, we will want to end the pain and the swelling the problem has caused. We may do this by placing a pad on your heel or in your shoe to act as a cushion. This is called a temporary orthotic. We may also wrap tape around your foot to give it support. Often we recommend a "5 Step" plan which includes (1) No Barefoot Walking, (2) Stretching Exercises for the heel, (3) Icing the affected area, (4) Anti-inflammatories, and (5) Wear the temporary orthotics. Later, when we see how this care helps, we may make you a more permanent support that will go into your shoe. This is called a permanent orthotic device.

Most people, 9 1/2 out of 10, will get better when their foot has some support, as from an orthotic device. But they will also need to have some physical therapy to help the body move blood quickly and heal faster.

Taking care of a heel pain problem is slow work. At times, we may need to apply a steroid injection that will stop the pain and swelling. You may also get a prescription for an anti-inflammatory medicine. The important thing is that it takes teamwork - you and us working together, regularly and often, to solve the problem.

Surgical Options

About two out of 100 people will need surgery to take off the heel spur and give the plantar fascia more room to move. Since we are also foot surgeons, we have the knowledge and training to handle this choice also.

Presently there are two surgical options. The first is called an Ossatron or Orthotripsy procedure. Although it is done in an outpatient surgery center, there is no incision and almost no down time. By using sound waves applied to the heel, the plantar fascia break up and provide the relief necessary to eliminate the pain. Full results from this procedure are not evident for about six months.

The second option is the traditional surgical procedure. Once again in a surgery center, we will make an incision about two inches long on the part of your heel closest to the middle of your body. Then we will cut free the plantar fascia from the heel bone a little bit so that it will be longer. At the same time, we remove the heel spur.

You will wear a special postoperative shoe for three to six weeks after surgery. Crutches will also be necessary for approximately the same amount of time. You will be able to move about, but not bend your foot. You can expect that your foot will swell and stay tender for several months. During that time, you will visit the office for therapy to aid the healing.

In either case, you will need to be patient. Since the foot is never completely still and must keep working, it takes longer to get well. The important thing to remember is that whatever choice we make together to help keep your heel healthy, you will keep moving and walking - with comfort.