The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Plantar fasciitis (heel pain), which is sometimes disabling, can occur in the front, back, or bottom of the heel and has a multitude of causes
There are numerous causes for plantar fasciitis. The most common is the result of faulty biomechanics, trauma, and poorly-fitted shoes. plantar fasciitis can be traced back to three main causes:
Heel Spurs: A bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. Heel spurs result from strain on the muscles and ligaments of the foot, stretching of the long band of tissue that connects the heel and the ball of the foot, and repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly-fitted or excessively-worn shoes, or obesity.
Plantar Fasciitis: Both heel pain and heel spurs are frequently associated with plantar fasciitis, an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot, and is painful. The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.
Excessive Pronation/Faulty Biomechanics: Heel pain sometimes results from excessive 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. Excessive pronation—i.e., excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
Other secondary causes for heel pain include:
Plantar fasciitis can be very painful but is very successfully treated when you seek the care of a professional. Typically we recommend patients come to see us after trying at-home remedies for a few days with no relief. If you have new onset heel pain that is unrelenting, there is concern for possible rupture or fracture and you must see us as soon as possible.
90% of patients with acute heel pain find complete relief with conservative measures. It is rare to require surgical intervention for heel pain, but there are circumstances when it is warranted.
Anti-Inflammatory Medication—Early treatment might involve oral or injectable anti-inflammatory medication.
Rest and Icing—Used to relieve pain and reduce swelling
Taping and Strapping—May be used for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attached to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery.
Physical Therapy—Often used to provide relief of the. Ultrasound therapy is a popular technique for treating fallen arches and their associated soft tissue involvement.
Custom-Molded Orthotics—These custom-made shoe inserts are useful in controlling foot function and may reduce symptoms and prevent worsening of the heel pain.
Amniotic Membrane Injections—New injectable medications on the market today contain sterilized and micronized amniotic membrane. Amniotic tissue is filled with anti-inflammatory blood products and growth factors that facilitate healing of injured areas, including the plantar fascia.
Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth. New modalities such as platelet-rich plasma, Topaz, and TenEx may also be used and are considered minimally-invasive.