Heel Pain

This section focuses on heel pain located on the bottom of the foot and heel, not the back near the Achilles tendon.  

There are several causes that can make your heels hurt and keep you from the active life that you want to enjoy.  The most common condition is a condition that is commonly called Plantar Fasciitis.  It is an awkward term for many to pronounce but when you have it, you do remember it!  Treating your heel pain requires getting a definitive diagnosis of the condition and not assuming that it is "just plantar fasciitis".  Dr. Rockwood has 20+ years diagnosing and treating heel pain, he has training to help distinguish the common conditions from the uncommon.  Come see us and get back on your active journey to enjoy your time on your feet.

One of the most common causes of heel pain is plantar fasciitis. This condition can affect people of all age groups, genders, and activity levels, from elite athletes to weekend warriors and everyone in between. Here's what you need to know about plantar fasciitis:

• What is Plantar Fasciitis?   Plantar fasciitis is an inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of your foot and connects your heel bone to your toes. This condition is often characterized by a sharp pain in the heel, especially with the first steps in the morning or after prolonged periods of rest.

• Symptoms of Plantar Fasciitis:
  • Sharp or stabbing pain in the heel
  • Pain that worsens with activity or after prolonged rest
  • Tenderness when pressing on the bottom of the heel
  • Swelling and redness in some cases

• Who Can Get Plantar Fasciitis?   Plantar fasciitis can affect anyone, but certain factors increase the risk, including:
  • Being overweight
  • Having flat feet or high arches
  • Wearing unsupportive footwear
  • Engaging in high-impact activities such as running or jumping

Recent research has provided new insights into the management and treatment of plantar fasciitis. A study by Morrissey et al. (2021) emphasizes the importance of accurate diagnosis and differentiating the location of pain. The use of diagnostic ultrasound has become a valuable tool in assessing the exact thickness of the plantar fascia and the condition of the surrounding tissue. This allows for a more precise and personalized treatment plan.

Another recent white paper highlights the effectiveness of eccentric exercise and heavy slow resistance training for managing plantar fasciitis. These exercises help strengthen the plantar fascia and surrounding muscles, leading to improved outcomes for patients.

While plantar fasciitis is a common cause of heel pain, it's not the only one. Here are other potential causes:

• Infracalcaneal Bursitis:   This condition involves inflammation of the bursa, a small fluid-filled sac that cushions the heel bone. Infracalcaneal bursitis can cause pain similar to plantar fasciitis but is often located more towards the center of the heel.

• Nerve-Related Issues:
  • Tarsal Tunnel Syndrome: A condition caused by compression of the tibial nerve as it passes through the tarsal tunnel near the ankle. It can cause pain, tingling, and numbness in the heel and foot.
  • Baxter's Neuritis: Involves compression of the inferior calcaneal nerve, leading to heel pain that may be mistaken for plantar fasciitis.
  • Compression Neuritis of the Calcaneal Nerves: Other forms of nerve compression can also lead to heel pain.

If you're experiencing heel pain, it's important to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan. Dr. Rockwood has treated thousands of cases of heel pain over 20 years and can provide precise and consistent diagnosis of the condition, along with customized treatment plans to meet your specific needs. Common treatments for heel pain include:

• Rest and Ice: Reducing activity and applying ice can help alleviate pain and inflammation.

• Stretching Exercises: Stretching the plantar fascia and Achilles tendon can relieve tension and improve flexibility.

• Supportive Footwear: Wearing shoes with good arch support and cushioning can reduce strain on the heel.

• Orthotic Devices: Custom-made or over-the-counter orthotics can provide additional support and comfort.

• Physical Therapy: A physical therapist can design a personalized exercise program to address your specific needs.

One of the main treatments for plantar fasciitis and infracalcaneal bursitis is corticosteroid injections. These injections provide quick relief and can offer 2-3 months of residual improvement. Here's what you need to know about corticosteroid injections:

• How Corticosteroid Injections Help:   Corticosteroids are powerful anti-inflammatory medications that can reduce swelling and pain in the affected area. When injected around the plantar fascia or bursa, they help to decrease inflammation and provide significant pain relief.

• Safety of Corticosteroid Injections:   Corticosteroid injections are generally safe when administered by a qualified healthcare professional. However, there are some potential risks and side effects, including:
  • Thinning of the fat pad at the injection site
  • Skin discoloration
  • Temporary increase in pain after the injection
  • Rarely, rupture of the plantar fascia.  Associated with improper technique or injection directly into the fascia.

• Dispelling Myths:   It's important to address some common myths about corticosteroid injections:
  • Myth: Corticosteroid injections are dangerous.   
    • Fact: When administered by a qualified professional, corticosteroid injections are generally safe and effective for treating heel pain.
  • Myth: Corticosteroid injections don't help.   
    • Fact: Corticosteroid injections can provide significant pain relief and improve the condition for 2-3 months, allowing patients to engage in rehabilitation exercises and other treatments.
  • Myth:  Steroid shots don't work on me. My shoulder shot didn't help at all.
    • Fact:  When place properly the medication in steroid injections will reduce inflammation, the key is to place medication correctly and in the source of pain or inflammation.

• Procedure and Recovery:   The injection procedure is relatively quick and is usually performed in a healthcare provider's office. The area is cleaned, and a local anesthetic may be used to numb the injection site. The corticosteroid is then injected into the most painful area. After the injection, you may experience temporary numbness, followed by pain relief over the next few days. It's important to follow your healthcare provider's instructions for post-injection care, which may include rest and avoiding high-impact activities for a few days.

Anti-inflammatory medications can play a crucial role in managing heel pain. Here's how they help:

• Purpose of Anti-Inflammatories:   Anti-inflammatory medications, such as ibuprofen or naproxen, are used to reduce inflammation and alleviate pain. They are particularly effective when taken at a specific dose for a short period of time, usually two weeks. This approach helps to decrease pain and improve the condition without long-term use.

• Safety and Effectiveness:   Anti-inflammatory medications are generally safe when used as directed by a healthcare professional. They can provide significant pain relief and improve the overall condition, making it easier for patients to engage in other treatments such as stretching exercises and physical therapy. j If you have sensitivity to aspirin, you should let your doctor know before taking other anti-inflammatory medications.

For individuals who have had plantar fasciitis for more than 6 months and have not found relief from conservative measures, there is hope for a more permanent solution. Endoscopic plantar fasciotomy (EPF) is a safe and effective surgical treatment for recalcitrant plantar fasciitis. This procedure is performed as an outpatient and takes about 5-10 minutes. You can walk the same day, return to regular shoes within a week, and resume many normal activities in 2-3 weeks. 

Dr. Rockwood's advanced training in nerve decompression, along with his evaluation and assessment skills, ensures precise diagnosis of heel pain conditions. With years of experience using diagnostic ultrasound, Dr. Rockwood has developed protocols based on specific findings and measurements of the tissue, providing tailored treatment plans for each patient.

Remember, heel pain is a common issue, and you don't have to endure it alone. With the right treatment and care, you can find relief and get back to your normal activities.