Heel Pain

What causes Heel Pain & Plantar Fasciitis?

Heel pain is one of the leading causes that patients visit Foot Care Center of Harrisonburg, VA to have treated. Plantar fasciitis (or heel pain) is commonly traced to an inflammation on the bottom of the foot. Dr. Gregory Shilling can evaluate your arch pain, and may advise certain types of shoes, activities to avoid or modify, use of a night splint (which can be dispensed to you at the visit and submitted to insurance), and rest, heat, and elevation of the foot. (Ice is better for an initial injury. Say, you just sprained your ankle. You would ice it to numb the pain and reduce swelling. Here, with plantar fasciitis, we want to increase blood flow to bring oxygen and nutrients to the tissue so it will heal. Ice reduces blood flow. So I disagree with so many web sites that say to ice it.) Physical therapy is not usually necessary to treat this condition.

In-office x-ray and sonogram will be used to confirm the condition.

The term “heel spur syndrome” is misleading. Everyone thinks of the spur as a ‘thorn’. Actually, a heel spur would more accurately be referred to as a ‘heel extension’. The heel extends the bone out to provide more bone for the plantar fascia or Achilles tendon to attach. This occurs when a person is on their feet a significant amount. One out of three people have heel spurs but are not in pain nor is it ‘bad’. The term “heel spur syndrome” probably comes from an incorrect belief that the spurs caused the inflammation. However, sonogram now being available, reveals that whether there is a spur present or not (and 2 out of 3 times there is no spur present) the condition is inflammation of the plantar fascia. This is due to too much strain to the plantar fascial tissue.

Often steroid injections may be advised at 2 to 3 week intervals and as appropriate to the degree of improvement. I have given many thousands of these injections over my 25 years of practice, such that with use of the sonogram to guide the injection, almost every patient agrees that the shot did not hurt much at all. Some of these patients are surprised how little it hurt after having had shots from other doctors or hearing from friends that the shot hurts a lot.

I find that by treating the whole condition: explaining what activities cause this, advising how to minimize stress to the heel, stretching, use of injections and orthotic devices as needed, very few patients need surgery.

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