Patients most commonly experience pain in their heel in two places: On the bottom (Plantar Fasciitis) or in the back (Achilles Tendinopathy). Both conditions are experienced by people from all ages and activity levels—from avid runners to weekend warriors to those who are on their feet all day at work.
Plantar Fasciitis – What is it?
Pain on the bottom of your heel when you first step out of bed is a classic sign of Plantar Fasciitis or inflammation of the plantar fascia. The pain also commonly occurs once you get up from sitting for an extended period of time during the day and may worsen again after climbing stairs, walking or standing for long periods of time. This condition often affects middle-aged people, as well as young people who spend a lot of time on their feet (such as athletes, soldiers or those whose jobs require a lot of standing or walking on hard surfaces).
This condition can also occur in those who have:
A tendency to over-pronate—your feet roll inward as you walk or run.
Worn out or ill-fitting shoes
Tight calf muscles or Achilles’ tendons
High arches or flat feet
What causes the pain?
A bone spur often appears on x-rays during diagnosis. However, it’s not the source of patient pain. The spur develops from the constant pull of the plantar fascia, which can be thought of as a rubber band on the bottom of your foot that maintains the integrity of your arch. When patients sleep at night or are off of their feet during the day, the fascia contracts as a rubber band would. When you step down after sitting or lying down for a period of time, the plantar fascia is quickly stretched out. As this band of tissue pulls on the heel bone where it is attached, small fibers of the tissue are pulled off of the bone. These small micro tears cause the fascia to become inflamed and are very painful.
Treatment for Plantar Fasciitis heel pain begins with a non-surgical approach. Once x-rays have ruled out any type of fracture or bone abnormality, we start with stretching exercises, anti-inflammatories, cortisone injections and shoe inserts (orthotics). From here, physical therapy, night splints, walking cast boots, and total non-weight bearing therapy are additional options if needed. One new alternative option to surgery is a laser technique that uses MLS Laser Therapy. Additionally, stem cell injections can also provide a safe and less invasive alternative to heel surgery.
For those individuals not responding to conservative treatment, surgery is an option. Endoscopic Plantar Fasciotomy is a minimally invasive procedure to release a portion of the plantar fascia.
Achilles Tendinopathy – What is it?
Pain in the back of the heel is associated with the Achilles tendon as it attaches to the back of the heel bone. Individuals with Achilles tendon pain are commonly suffering from a form of tendinopathy: tendonitis, inflammation of the Achilles tendon, or tendinosis, which are microtears in the tendon caused by overuse. This latter condition is usually the source of the tendon pain our patients are feeling. These tiny tears in the tendon most often occur over time. Repeated stopping and starting movement during sports or work causes additional pull on the back of the heel.
What causes the pain?
Like plantar heel spurs, bone spurs can also develop in the back of the heel as a result of the constant pull of the Achilles tendon. In some individuals, these spurs can weaken the attachment of the Achilles tendon, causing the micro tears, inflammation and pain. In extreme cases, the tendon’s attachment to the back of the heel can be so disrupted that the tendon can pull off of the bone completely.
Symptoms include mild or severe pain, as well as swelling and reduced range of motion in the ankle area.
Conservative treatment for this type of heel pain includes rest, ice, and decreased activities. Oral and topical anti-inflammatories, heel lifts in your shoe (which help to reduce the pull from the tendon, offsetting a short Achilles tendon), and general shoe modifications can also help. If these methods, along with night splints, ankle braces, walking boots, and non-weight bearing therapy provide no significant relief, consider trying the MLS laser treatment. Finally, surgery is an option if significant progress is not made with these other interventions. Removing a portion of the heel spur and scar tissue from the back of the heel can typically give patients significant relief!
We are experts in diagnosis and treatment, offering patients a step-by-step approach to combatting both acute and chronic heel pain. Our goal is to get our patients fully recovered, pain-free and back to the active lifestyle they love as quickly as possible.
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