Pain is located in the center of the heel into the arch. This problem is one of the most common foot conditions. It causes pain just getting up after sitting or in the a.m. With fasciitis it is very common for an x-ray to show no heel spur.
We use the terms plantar fasciitis and heel spur interchangeably for heel type pain.
There are many structures attached to the heel bone. The primary structures are the plantar fascia and plantar muscles. As we walk or run the arch flattens to absorb the body's weight, causing stress on the fascia and pulling away of the heel bone, causing a bone spur. It normally takes years to develop spurs. Pain in the heel can be caused by the bone, fascia or heel nerve.
Poor fitting shoes can exacerbate the pain. The cost of the shoes is not as important as the fit. Make sure you have your feet measured once a year when buying new shoes. You should use well cushioned and supportive shoes with good lateral support.
The pain can be centrally located in the heel or arch it can be worse in the morning and after sitting but improves as the day goes on. The pain with first steps in the morning and after rest is caused by pulling of the fascia and plantar muscles off of the heel bone. If you have pain—without weight bearing—that is shooting in nature, it is caused by the nerve on the side of the heel.
Heel spurs are caused by inflammation at the insertion of the plantar fascia into the heel bone. The condition can be treated successfully using a conservative approach in 98% of the cases. Diagnosis includes a physical exam and possible an x-ray, especially if there is a history of trauma. Heel pain can be reduced by using trigger point injections of a mild steroid from the side of the foot with a cold spray to numb the skin to significantly reduce the pain from the injection. Typically, treatment requires 1 to 3 office visits for evaluation and injections. If nerve pain is present that causes shooting pain at rest, this can be treated with dehydrated alcohol injections to destroy the painful section of the nerve.
As we start treatment it's important to support the arch with an OTC arch support, wrapping the arch with reusable wraps or coban. When treating long term, Custom Orthotics are often the best choice. They are constructed from a flexible plastic material and can made to fit both gym and dress shoes.
If heel pain is intolerable or persists after conservative treatment, new treatments are available—PRP (platelet rich plasma) injections or Shockwave Therapy. Surgery today is rare but, if necessary after all treatments, it is usually successful.