Heel pain is common—approximately 10% of the American population will experience it—but that doesn’t mean it’s normal. In fact, heel pain is a problem, one that can keep you away from favorite activities and being able to enjoy your life.
On top of that, the pain won’t just go away if you ignore it and keep doing your normal routine. That will typically make the situation worse.
Fortunately, about one million of affected individuals do the smart thing in making appointments to seek professional medical care – like the kind Dr. Fox provides here at our Long Island office.
Understanding Plantar Fasciitis
When it comes to heel pain for adults, the leading cause is a condition known as plantar fasciitis. Now, the name for this particular soft tissue injury is a bit of a misnomer – “-itis” implies tissue inflammation, which isn’t usually the case.
Rather, it would be more accurate to call the problem either plantar fasciopathy or plantar fasciosis. To make things easier for you, we’ll stick with “plantar fasciitis,” since it’s most commonly used.
Here’s the deal, though:
No matter what it is or isn’t called, this condition causes sharp pain in the bottom of the heel with the first steps of the morning, or after you stand up following an extended period of sitting.
Why does this happen? Where is all this pain coming from?
Well, to answer those questions, let’s start by answering a different one – what is the plantar fascia?
Your plantar fascia is a thick, fibrous band of tissue running lengthwise along the bottom of your foot and connecting the heel bone (calcaneus) to the ball of the foot. It is also sometimes called the plantar aponeurosis.
(Again, we’ll stick with “plantar fascia,” because more people know it as such.)
This particular fascia is incredibly important. It stretches when you stand and builds up kinetic energy to propel you into your next step when you walk or run. Additionally, your plantar fascia supports your foot arch, creating stability and aiding in proper foot function throughout the entire gait cycle.
All of this means that your plantar fascia must both stretch AND support at the same time. No wonder it’s so easily damaged (and such a problem when it is)!
What Causes Plantar Fasciitis?
From a general point of view, the root cause is mechanical in nature.
It is commonly believed that there is excessive pulling of the plantar fascia at its attachment to the heel bone. This is probably true in many cases. As a result, the fascia tissue can be overstretched and sustain microscopic tears – resulting in irritation, inflammation, and degeneration.
But that isn’t the only thing going on here.
When you stand, weight is transmitted down through your heel bone, thereby crushing the structure right under it (which happens to be the plantar fascia). So, your poor plantar fascia is both overstretched AND crushed. This is painful plantar fasciopathy.
What Are Plantar Fasciitis Signs and Symptoms?
As previously noted, the key signs of this condition include:
- Pain when getting up in the morning, often easing up after a few steps
- Pain when getting up after sitting
- Pain in the heel right where the arch begins
How is Plantar Fasciitis Diagnosed?
Understanding the symptoms is a great starting point, but there may be more work needed to accurately diagnose the condition. In this case, we are talking about tools and methods such as:
- A comprehensive history and physical exam.
- X-ray. This tried-and-true diagnostic test is valuable for ruling out other causes of heel pain. For example, a heel spur may be seen on x-ray. If we do see one, though, it doesn’t necessarily explain the pain you feel – many plantar fasciitis patients don’t have heel pain, and we do see heel spurs in x-rays of many “normal” feet.
- Ultrasound/Sonogram. Tests like these are essential for measuring and evaluating the plantar fascia, especially to guide effective treatment and predict outcomes. You can think of this as being "a must" when addressing this condition.
- Diagnostic nerve block. Neuritis is often present and contributes to your heel pain. Using a diagnostic nerve block can help to rule that either in or out.
- MRI. When we order an MRI (magnetic resonance imaging), there are a couple of possible reasons for doing so. It might be we suspect that a more severe rupture has taken place. Or we may use this diagnostic imaging when symptoms are more neurological in nature (such as pain in the toes or areas not typically affected by plantar fasciitis). In the second case, we are usually looking for any lesions—like a ganglion—in the tarsal tunnel area of your foot.
Plantar Fasciitis Treatments
Treatment for plantar fasciitis can be either conservative or surgical in nature. The course Dr. Fox recommends for your case will depend on an array of factors. He will typically use ultrasound to get a better idea as to the extent of the damage to the tissue. Based on this information, Dr. Fox can predict how likely you are to respond to conservative vs. surgical treatment plans.
When nonsurgical care is recommended, it is important to keep in mind that all options have various degrees of success and failure rates. That said, some patients find success with treatments like:
- Extracorporeal Shockwave Therapy (the most advanced of non-invasive, conservative treatment options)
- Ice therapy
- Appropriate stretches
- Physical therapy
- Motrin (or other pain/anti-inflammatory medication)
- Tape immobilization
- Night splints
What About Cortisone Injections (and Other Injection Therapies) for Plantar Fasciitis?
You will certainly find cortisone injections to be a treatment tried early and often within the podiatric community to treat this condition.
Whereas they’re nonsurgical in nature, injections are invasive and have varying degrees of success.
Dr. Fox believes one cortisone shot can sometimes be beneficial. More than that, a single injection can be used as a diagnostic aide (when this relieves symptoms, it’s more likely that the problem actually is plantar fasciitis).
To allow for a reduced amount of steroid and decrease the potential for error, a cortisone shot should be performed with ultrasound guidance – and Dr. Fox follows this practice when applying this treatment.
In addition to cortisone shots, other possible injection therapies include:
- PRP (platelet-rich plasma). Your own blood is drawn from your arm, centrifuged to concentrate platelets, and then injected into the painful area. Platelets have growth factors which can help heal damaged tissue. This can be an in-office procedure.
- BMAC (bone marrow aspirate concentrate). This is a little more invasive than PRP, since it requires harvesting your own bone marrow from your hip or heel bone. Bone marrow has progenitor cells which (in theory) can help form new, healthy tissue in areas of damage.
- Amniotic/placental stem cell allografts.
- Naturopathic/Homeopathic preparations (usually containing Arnica).
- Alcohol injections. This is highly successful when there is a neuritis component, particularly in cases with pain around the "rim" of the heel.
What Are Surgical Options?
Our treatment of choice at Massapequa Podiatry Associates is UltraSound-Guided Percutaneous Partial Plantar Fasciectomy (USGPPF).
In this procedure, small amounts of degenerated tissue are removed from the plantar fascia through a tiny incision on the inside of the heel. This is performed while being visualized with ultrasound technology.
After adequate removal of bad tissue, platelet-rich plasma or amniotic stem cells are injected back into the area. Recovery is very quick, with little restriction needing to be placed on normal activities. The plantar fascia ligament is preserved in its natural length and the mechanical function of the foot is not altered.
Other surgical techniques include:
- TOPAZ – radiofrequency waves are used to "ablate" damaged tissue
- TENEX – intense ultrasound waves break down diseased tissue
- EPF (endoscopic plantar fasciotomy)
- In general, patients should be monitored yearly after resolution of the pain from these procedures.
Foot orthotics may be helpful in preventing reoccurrence (since they directly address the mechanical causes). Good nutrition, exercise, and maintaining proper weight are essential for optimal recovery and reducing the risk of recurrence. Appropriate, properly fitting shoes are certainly beneficial, as well.
Find Relief from Your Heel Pain at Massapequa Podiatry Associates Today!
Don’t let heel pain get in the way of your life! Instead, let Dr. Fox and his team help you overcome painful symptoms and find the relief you deserve.
For more information—or to request your appointment—simply give us a call at (516) 541-9000