Heel Pain Becoming Too Much to Bear

By Dr. Esther Lyon DPM

Pain in the morning? How about when you stand after sitting for a few minutes? More people needlessly suffer from heel pain than any other foot ailment. Fortunately, much can be done to alleviate this pain. Patients often have pain first thing in the morning or after getting up to stand after sitting. The pain can be a sharp, searing pain or present as a tearing feeling in the bottom of the heel. As the condition progresses there may be a throbbing pain after getting off your feet or a soreness that radiates up the back of the leg or arch of the foot.
To understand the cause of the pain one must understand the anatomy of the foot and some basic mechanics in the function of the foot. A thick ligament, called the plantar fascia, helps form the arch of the foot. The plantar fascial ligament attaches from the heel bone to the ball of the foot, providing the supportive architecture for our feet.
The plantar fascial ligament is made of dense, fibrous connective tissue that will stretch very little. It act something like a shock absorber. As the foot impacts the ground with each step, it flattens out lengthening the foot. This action pulls on the plantar fascia, which stretches slightly. When the heel comes off the ground during walking or running the tension on the ligament is released.
Anything that causes the foot to flatten excessively will cause the plantar fascia to stretch greater than it is accustomed to doing. One consequence of this is the development of small tears where the ligament attaches to the heel bone. As the foot overpronates during walking the excessive tension on the plantar fascial ligament causes tears from its attachment into the heel bone.
Excessive flattening of the arch is termed pronation. If there is excessive pronation of the foot during walking or standing, the plantar fascial ligament is strained. Over time, this will cause a weakening of the ligament where it attaches into the heel bone, causing pain. When a person is at rest and off their feet, the plantar fascial ligament attempt to mend itself. Then, with the first few steps the ligament re-tears, causing pain. A cycle of pain is begun. If you find yourself with this cycle of pain, it is time to have it addressed. Chronic inflammation of the heel may result if this condition goes untreated.

Diagnosis
The diagnosis of heel pain is made by a thorough history of the course of the condition and by a physical examination. Weight bearing x-rays are useful in determining if a spur is present and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.

Treatment
The good news is conservative treatment can successfully treat plantar fasciitis almost 95% of the time. Diagnosis includes a physical examination and x-ray. In the office a sonogram is performed which produces imaging of the plantar fascial ligament and gives details and measurements of the inflamed area. Once diagnosed, plantar fasciitis is generally resolved with physical therapy, taping of the foot, orthotics to prevent over pronation, and instruction on home exercises.
A new treatment called shockwave therapy, or lithotripsy, has assisted many patients with more severe cases of plantar fasciitis. Other successful procedures include endoscopic and sonogram guided release of the inflamed plantar fascial ligament. These procedures require two stitches with the patient able to walk the same day.

If your heel pain has become too much to bear, it is time to take a closer look.

The good news is that heel pain can often be relieved quickly and with little discomfort to get patients back on their feet.