Do You Have Heel Pain? You May Have Plantar Fasciitis
May 6, 2015
by Julia A. Rabadi, DPM, AACFAS
Do you feel that? The sun is shining a little brighter, the temperature is a little warmer, and that bleak winter is now a figment of the past. Perfect timing to break out those sneakers collecting dust in the closet and go for a run. Or better yet, slip on those darling flip-flops, which have been calling your name since last September! Just as you begin to enjoy all that spring has to offer- ouch! - an annoying throbbing in the heel at first, then a sharp debilitating pain which causes you to limp in even your “comfortable shoes”. It can start in your heel and extend as far as your arch. A quick inquiry into "Doctor Google" and you find out you may in fact have what is termed plantar fasciitis!
In fact, heel pain caused by plantar fasciitis is one of the most common ailments seen by foot and ankle surgeons, accounting for approximately 10-16% of the human population1, most often in patients 40-60 years of age, and more commonly seen in the female gender. It is termed an “overuse injury” at the origin of the plantar fascia from excessive pronation, which would then cause inflammatory and often degenerative changes to the fascia.
Possible Causes of Plantar Fasciitis
Risk factors often include but are not limited to poor shoe-gear (i.e. thin soled, flat, and/or loose fitting shoes), occupations which require standing for lengthy periods of time (athletes, nurses, beauticians, mechanics, letter carriers, and retail workers, to name a few). Plantar fasciitis also affects pregnant women, those who are overweight, and those who lack adequate ankle flexion required for normal gait.
Diagnosing Plantar Fasciitis
The list of differentials is lengthy; therefore a proper work up by a skilled podiatrist is necessary. Radiographs, also known as x-rays, are the most common diagnostic test performed for heel pain due to the close relation to heel spur syndrome. However, it is reported that 27% of people without symptoms have had x-rays positive for heel spurs, or calcaneal spurs. Ultrasounds, computer tomography (CT) scans, bone scans, MRIs, and nerve conduction velocity/ electromyography tests have also been shown to be beneficial in diagnosing causes of heel pain.
Treating Plantar Fasciitis
Once properly diagnosed, treatment varies from conservative to surgical managements. From the conservative end of the spectrum, low dye strapping has been an effective treatment modality in mild to moderate cases. Over time, the tape loosens, but is a good indicator of orthotic efficiency. Footwear modifications including the use of orthotics have had an 80% success rate2 as compared to NSAIDs (i.e anti-inflammatory agents), which have a reported 33% success rate. Stretching of the Achilles tendon, physical therapy and night splints have also shown some success in the battle against fasciitis. Corticosteroid injections have also been proven successful in the moderate to severe cases of plantar fasciitis. However, it is estimated that 10-25% of individuals affected by plantar fasciitis fail conservative treatment3-5.
Extracorporal shock wave therapy is slowly gaining notoriety as a favorable treatment modality for plantar fasciitis since the FDA approved it in 2000. Non-invasive acoustic waves are emitted to the damaged tissues to create microtrauma, which then stimulates the healing response and micro-vascularization6. There is no “down time” and an immediate return to activity or work is acceptable.
In the surgical arena, there are myriad options. Open and endoscopic plantar fasciotomies release the fascia from the origin. Success rates vary from 40-80% respectively7-8 but complications such as nerve entrapment, heel fractures, pain at the incision site, infection as well as pain on the outside of the foot may ensue. For a full list of management options including a proper full work up, give Certified Foot Care a call. We’d be happy to talk to you about them.
1. Riddle DL, et al. Risk Factors for Plantar Fasciitis: a matched case-control study. JBJSA 2003; 85: 872-7.
2. Lynch DM, et al. Conservative Treatment of Plantar Fasciitis. A Prospective Study. JAPMA 1998; 88 (8): 375-80.
3. Alfredson H, et al. Heavy-loaded eccentric calf muscle training for the treatment of chronic Achilles tendinosis. AJSM 1998; 26 (3): 360-6.
4.Davis PF, et al. Painful heel syndrome: results of non-operative treatment. FAI 1994: 15 (10): 531-5, 4.
5. Malay DS. Plantar Fasciitis and Heel Spur Syndrome: a retrospective analysis. In: Vickers NS, editor. Reconstructive surgery of the foot and leg: update 1996. Tucker (GA): Podiatry Institute Publishing; 1996. P. 39-43.
6.Saxena A, et al. Comparison between extracorporal shockwave therapy, placebo ESWT and endoscopic plantar fasciotomy for the treatment of chronic plantar heel pain in the athlete. Muscles Ligaments Tendons Journal 2013; 2 (4): 312-6.
7. Contompasis JP. Surgical Treatment of Calcaneal Spurs: a three year post-surgical study. JAPMA 1974: 64 (12): 987-99.
8. Hogan KA et al. Endoscopic Plantar Fascia Release. FAI 2004; 25 (12): 875-81.