Heel Pain & Plantar Fasciitis - Causes, Symptoms & Treatment Options
Heel pain is one of the most common conditions podiatrists treat. It accounts for approximately 15-20% of North Shore Foot & Ankle's practice. Most patients with heel pain find that it is most painful with the first few steps in the morning and after prolonged sitting. The condition can occur in anyone, but is most common in athletic or overweight people. Feet that flatten excessively are also more likely to develop it.
A strong ligament called the plantar fascia (Figure 1) extends from the heel bone to the toes. When the foot flattens, the plantar fascia becomes taut. It stretches, and begins to pull away from the heel. This causes pain. Over time, the pulling stimulates the heel bone to produce a heel spur (Figure 2). The heel spur itself is usually not the cause of the pain.
Most of our patients gain relief from conservative treatments which include:
- Icing and stretching exercises performed daily.
- Taping the foot in a manner that relaxes the plantar fascia by controlling pronation (flattening).
- Orthotics (custom supports) to relax the plantar fascia by controlling pronation.
- Modification of exercise routines.
- Changing to shoes with good support and heel cushioning.
Other conservative treatments include: cortisone injections, oral anti-inflammatory medications, physical therapy, and night splints.
Laser Treatment of Plantar Fasciitis
In recent years, the doctors of North Shore Foot & Ankle have successfully treated persistent heel pain with the K-Laser. The laser safely and painlessly penetrates deep tissue. This non-invasive treatment stimulates the plantar fascia to heal. Most patients respond after six to eight treatments, administered twice weekly. Although not yet covered by most insurance, North Shore Foot & Ankle has reasonably priced this service.
When conservative treatment fails to resolve plantar fasciitis, surgery is indicated. Fortunately, the days of removing heel spurs, or even cutting the plantar fascia are over. The doctors of North Shore Foot & Ankle perform the Topaz® procedure. Tiny punctures replace an incision over the affected portion of the plantar fascia. A thin radiofrequency "wand" is inserted into each puncture, and radiofrequency energy is used to remove small amounts of tissue from the fascia. This stimulates the body to heal the fascia, along with the fasciitis. The procedure is minimally invasive and takes about 15 minutes. If you are a candidate for the Topaz® "micro-fasciotomy", your doctor will give you a detailed explanation of the surgery and its post-operative course.