Heel Spurs & Plantar Fasciitis
Because there are several potential causes, it is important to have your heel pain properly diagnosed. Dr. Jeffery Feld is a trained foot and ankle surgeon who is able to distinguish between all the possibilities and determine the underlying source of your heel pain to achieve relief of pain.
What is Plantar Fasciitis?
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain that may extend to the toes.
Causes
Wearing non-supportive and non padded footwear on hard, flat surfaces puts an abnormal strain on the plantar fascia. This is particularly evident when one’s job requires long hours on the feet or walking on concrete flooring.
Heel Spurs
A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, typically visible by X-ray, appears as a protrusion that can extend forward from the heel or calcaneous. When there is no indication of bone enlargement, the condition is sometimes referred to as “heel spur syndrome” or bursitis.
Heel spurs result from a strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitting shoes.
Pronation
Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.
As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the heel.
Some general health conditions can also bring about heel pain:
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Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint, can cause heel discomfort in some cases.
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Heel pain may also be the result of an inflamed bursa (bursitis), a small, irritated sack of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur.
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Haglund’s deformity (“pump bump”) is a bone enlargement at the back of the heel bone, in the area where the Achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe.
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Pain at the back of the heel is associated with inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. The inflammation is called Achilles tendinitis. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.
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Bone bruises are common heel injuries. A bone bruise or contusion is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.
People with plantar fasciitis often describe the heel pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain typically decreases, as walking stretches the fascia band.
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery.
Treatment
Stretching exercises
Exercises that stretch out the calf muscles may help ease pain and assist with recovery.
Avoid going barefoot
When you walk without shoes, you put undue strain and stress on your plantar fascia.
Ice
Putting an ice pack on your heel for 10 minutes several times a day helps reduce the inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to skin.
Limit Activities
Cut down on extended physical activities to give your heel a rest.
Injection Therapy
In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
Shoe Modification
Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
Padding and strapping
Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
Orthotic devices
Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
Night Splint
Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients. Exercises and other physical therapy measures may be used to help provide relief.
Podiatry Care for the Entire Family
I have been coming to see Dr. Feld and his staff for many years. Every time I walk into the office I am greeted with a cheerful smile and "Hello" from the staff members and never wait more than 5 minutes before I am brought back to be seen. They work around my schedule and answer any questions I may have. I highly recommend!!
Amber HartmanDr. Feld is one of the best medical providers I have seen. He cured my poor little foot and now I walk around pain free. Thank you so much for helping me and working with my crazy schedule!
Brianna PewCaring, honest and has lots of knowledge. I was very satisfied with the care Doctor Feld provided and the surgery which was performed on my hammer toe. I will return and get the other toe worked on (once the summer is over.)
Charney JeanWonderful Facility!!! Came in for something I though was minor and actually found out I broke my foot in two places!!! Dr. Feld and staff were extremely helpful and talked me through the treatment and got me fitted for one of there boots. Everything healed very nicely and if I ever have any additional problems with my feet I know who I will be calling!!
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