Ranging from meek discomfort to incapacitation, heel pain affects over 2 million
American every year. The most frequent cause of heel pain is inflammation of the connective tissue band that runs on the bottom of the foot called the plantar fascia. When this band is inflamed, torn, or ruptured it can cause a significant amount of pain which medical professionals deem “Plantar Fasciitis”. The plantar fascia supports the arch of the foot, and is susceptible to calcifications called heel spurs. A common misconception is that the heel spur is the cause of the heel pain. In about 50% of cases people with heel spurs have no symptomatic heel pain.
There are many causes of plantar fasciitis. Individuals who run or stand for long periods of time on hard surfaces or have a tight Achilles tendon and calf muscle are susceptible for strain and micro tears of the plantar fascia. Patients that are over weight, have high or flat arches, or wear poorly fitting shoes may also strain the plantar fascia. The key symptom of plantar fasciitis is pain on the first steps in the morning, called “Postatic dyskinesia”. Pain often occurs after long periods of rest, standing for long periods of time, and being very active throughout the day. Pain of the heel bone closest to the arch when pressed on is positive for plantar fascial irritation. A combination of patient history and clinical exam will be enough for most doctors to diagnose plantar fasciitis.
There are other foot diseases that may manifest as heel pain. These include calcaneal stress fractures, tarsal tunnel syndrome, fat pad atrophy, posterior tibial tendonitis, and Subtalar joint arthritis. Radiographs, therapeutic/diagnostic injections, nerve conduction velocity tests, or MRI studies may rule many of these diagnoses out. Once the diagnosis has been made there are many ways to treat the heel pain caused by plantar fasciitis. Part 2 of this entry on Monday will explore these options.