Heel pain is one of the most common complaints that we see in our practice. Usually, the underlying cause is plantar fasciitis. There is a tight band under the arch of the foot called the plantar fascia. The plantar fascia is supposed to support the arch and stay tight to help propel the foot forward in normal walking. If the arch is collapsing even just a little bit, this can put added stress on the plantar fascia causing inflammation and swelling. Another cause of plantar fasciitis is an overuse type syndrome. Typically, these type of patients recently started an exercise program or running, or maybe they just walked all day in the city in unsupportive shoes. This abnormal overuse can stress out the plantar fascia and cause inflammation.
First step in the morning pain is very common with plantar fasciitis. What is happening is that overnight, the plantar fascia is tightening up on itself and trying to heal. When you step on it in the morning, you are stepping through all of that new healing and that is why it is most painful in the morning.
In our office on the first visit for heel pain, we perform x-rays and a diagnostic ultrasound to get a good look at the plantar fascia as well as the heel bone. Sometimes on the x-ray we can see a large heel spur associated with the plantar fascia where it attaches to the bone and pulls on it. Of course, not all heel pain is caused by plantar fasciitis so we must rule out any other causes.
Treatment varies from simple orthotics to surgery. However, approximately 95% of patients get better WITHOUT SURGERY. Most offices will treat every patient with heel pain the same: maybe administer a cortisone injection and give it two weeks. In our practice, we perform a special test called the low dye test to see what treatment YOU will do best with and then we bring you back right away to treat you and get you pain free as fast as possible.