Heel Pain – Heel Spurs and Plantar Fasciitis
When pain is located in the center of the heel into the arch when you first get up in the morning or after sitting for a period of time you likely have heel pain with associated plantar fasciitis.. This problem is one of the most common foot conditions. It causes pain from pulling the insertion of the plantar fascia away from the heel bone.There are other foot problem’s that can cause heel pain, Achilles tendinitis, nerve pain( burning pain with no weight on foot ), injury to the heel and in children its called Sever’s disease which is inflammation to the growth center of the heel bone. This problem in children is between the ages of 8 to 12 years old.The great new’s with heel pain and plantar fasciitis is conservative treatment works well over 90% of the time.
Causes of Heel Pain
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.X-Ray’s sometimes so a heel spur but they can be small to very large. The size of the spur is not always related to the level of pain.In some cases there is no heel spur present.
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.When the pain first starts it’s important to always wear shoe’s to reduce trauma to he heel area.
Signs and Symptoms of Plantar Fasciitis and Bone Spurs
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.
Treatment for Plantar Fasciitis and Bone Spurs
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 made 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.If sugery is necessary we can use a new advanced proceduce called Tenex. This procedure removes the damaged tissue to allow correct healing. Call us the next time you need a heel pain doctor in Kansas City.