Heel pain is the most common musculoskeletal complaint of patients presenting to podiatric practitioners throughout the country. It is well-recognized that subcalcaneal pain syndrome, commonly
attributed to plantar fascitis, is a disease entity that is increasing in its incidence, owing partly to the fact that it has a predilection for people between the age of 40 and 60, the largest age
segment in our population.
Plantar fasciitis occurs because of irritation to the thick ligamentous connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue contributes to maintaining
the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. Therefore, the stress placed on the this tissue is tremendous.
Patients experience intense sharp pain with the first few steps in the morning or following long periods of having no weight on the foot. The pain can also be aggravated by prolonged standing or
sitting. The pain is usually experienced on the plantar surface of the foot at the anterior aspect of the heel where the plantar fascia ligament inserts into the calcaneus. It may radiate proximally
in severe cases. Some patients may limp or prefer to walk on their toes. Alternative causes of heel pain include fat pad atrophy, plantar warts and foreign body.
During the physical exam, your doctor checks for points of tenderness in your foot. The location of your pain can help determine its cause. Usually no tests are necessary. The diagnosis is made based
on the history and physical examination. Occasionally your doctor may suggest an X-ray or magnetic resonance imaging (MRI) to make sure your pain isn't being caused by another problem, such as a
stress fracture or a pinched nerve. Sometimes an X-ray shows a spur of bone projecting forward from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed
surgically. But many people who have bone spurs on their heels have no heel pain.
Non Surgical Treatment
Teatment of plantar fasciitis can be a long and frustrating process for both the coach and athlete. If you do not have a firm grasp of the goals of this rehabilitation program your best advice will
be to find a professional who routinely deals with athletic injuries. The "down time" for plantar fasciitis will be at least six weeks and up to six months of conservative care before drastic
measures like surgery should be considered. The goal of this rehab program is to initially increase the passive flexion of the foot eventually leading to improvements in dynamic balance and
flexibility of the foot and ankle, followed by a full return to function.
Surgery is considered only after 12 months of aggressive nonsurgical treatment. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles
place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches. In gastrocnemius recession, one of
the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope,
an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage.
Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is
partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an
open incision. In addition, endoscopy has a higher risk of nerve damage.