Heel Pain (Plantar Fasciitis, Heel Spur)
Plantar fasciitis is one of the most common complaints of the foot and ankle. It has been
reported to account for 15% of all adult foot complaints requiring professional care, and is prevalent among both active and non-active populations.
Plantar fasciitis has been estimated to affect approximately two million Americans per year, and may affect as much as 10% of the population during the course of one’s lifetime. It is more common in individuals over 40 years of age.
The etiology of plantar fasciitis is poorly understood. The term is synonymous with “heel spur
syndrome” and “painful heel syndrome.”
Plantar Fasciitis is described as a fibrofatty degeneration of the plantar fascial origin with microtears in the fascia and collagen necrosis. Plantar fasciitis may therefore represent both a degenerative and inflammatory process.
In a study done by Riddle in 2003 the most important risk factor identified was reduced ankle flexion range of motion. Obesity is another risk factor for plantar fasciitis. In another study done by Labovitz et al tight hamstring was discussed as another risk factor.
Patients usually present with pain directly at the plantar medial side of the heel. Pain is typically described with the first step in the morning, or after periods of rest. The pain may improve after the first step, but overall the pain can worsen over the course of the day. In more severe cases, the pain at the heel can be constant, even present when the patient is sleeping. The pain is often described as deep and sharp. Pain can radiate into the arch sometimes.
Conservative therapy for plantar fasciitis includes stretching, icing, nonsteroidal
anti-inflammatory drugs, low-Dye taping, orthotics, night splints, physical therapy, rest,
changes in shoe gear, and patient education. Corticosteroid injections, and platelet rich plasma injections have also been suggested.
Orthotics are a mainstay of conservative treatment for plantar fasciitis. A study in 2006 followed 43 patients with plantar fasciitis. The study found that combining custom foot orthoses with an elastic night splint provided greater short-term and long-term reduction of pain than using a night splint alone. Another study in 1999 had 5 groups of patient trying different conservative treatment for plantar fasciitis and the group with orthotics outperforms the other groups.
Corticosteroid injections are also a popular modality. Evidence has shown effectiveness of corticosteroid injection for initial management of plantar fasciitis
The injections should avoid the fat pad, and are placed deep, just superior to the origin of the
plantar fascia .At Empire Foot and Ankle Center we perform our heel injection under the guidance of ultrasound for better results. . Common risks of corticosteroid injection include rupture of the plantar fascia and loss of the fat pad.
It has been estimated that 5% of patients diagnosed with plantar fasciitis will undergo
surgery. Surgery should not be considered before six months to a year of conservative treatment.
At Empire Foot and Ankle Center we use modern equipment and evidence base medicine to treat patient with plantar fasciitis and surgery has always been our last resort. If indicated, we perform the endoscopic surgery for better results and less invasiveness.
We have treated over 1000 patients from Upland, Ontario, Chino, Claremont and Rancho Cucamonga for plantar fasciitis with great results. We also offer PRP (Platelet Rich Plasma) injection for patients suffering from plantar fasciitis.
At Empire Foot and Ankle Center we perform most of our injections including plantar fasciitis injections and other foot and ankle injections if indicated under the guidance of our modern ultrasound machine for better results.