By Arizona Foot & Ankle Specialists, LLC
August 10, 2021
Category: Foot Issues
Tags: Heel Pain  

Introduction:

Heel pain is one of the most common conditions we treat here at Arizona Foot and Ankle Specialists. Heel pain can result from many heel paindifferent causes. These may include local inflammation to the plantar fascia; a long thick ligament to the bottom of your foot, lower back problems, or some rheumatologic problems. But most common causes of plantar heel pain are plantar fasciitis, atrophy to the plantar fat pad (cushion), calcaneal stress fracture, or entrapment of the nerves around the heel area.

Risk factors:

  • Obesity

  • Sudden increase in activity

  • Inappropriate footwear

  • Biomechanical abnormalities

  • Trauma

Common findings:

Most commonly if plantar fasciitis is the main component of heel pain, pain exacerbates with activity after a period of rest. This phenomenon is referred to as post kinetic dyskinesia. If you are experiencing sharp pain to the bottom aspect of heel, with activity after a period of rest, you may have a component of plantar fasciitis. Similar symptoms maybe experienced due to other problems such as fat pad atrophy, tarsal tunnel syndrome, lower back radiculopathy, or some systemic cause. It is very important that a thorough and proper evaluation is performed in order to identify the main root of symptoms and then develop an appropriate and personalized treatment plan.

Evaluation:

Through physical exam, with proper history, is required for a proper diagnosis. At Arizona Foot and Ankle Specialists, we perform a detailed examination and may order laboratory work or advanced imaging to properly diagnose heel pain.

Imaging:

Part of your visit for heel pain will involve taking x rays in our office. On x rays there may or may not be a bone spur to the bottom aspect of the heel bone. Bone spurs are usually NOT the cause of heel pain. Instead, bone spurs result as response to increased tension to the bone (in this case heel). Presence of bone spurs usually means chronic tension from the plantar fascia.

Treatment:

Once the cause of your heel pain is identified, we design a personalized treatment plan. Every patient and every heel pain are different. Therefore, we design a personalized treatment plan for every patient. What worked for one patient in resolving their heel pain, does not mean will work for another patient. There are multiple ways to treat heel pain. Some of the treatment options available at Arizona Foot and Ankle Specialists include:

Conservative care:

  • Personalized stretching program

  • Orthotic management (prefabricated-medical grade, and custom options are available)

  • Corticosteroid therapy

  • Physical therapy

  • Shoe gear change and recommendation

  • Brace therapy

  • EPAT (shockwave therapy)

  • Anti-inflammatories

  • Activity modification

Surgical:

  • We offer Both traditional open vs. Minimally invasive surgical options. Surgical procedure is determined based on the severity of the problem.

Conclusion:

Heel pain is one of the most common conditions seen at Arizona foot and ankle specialists. Plantar fasciitis is not always the cause of heel pain and that’s why it is very important that the etiology of heel pain is identified and only then a personalized treatment plan can be created. At Arizona foot and ankle specialists, we provide individual care and personalized treatment plans for every patient.

References

1. Malahias MA, Cantiller EB, Kadu VV, Müller S. The clinical outcome of endoscopic plantar fascia release: A current concept review. Foot Ankle Surg. 2020 Jan;26(1):19-24.

2. Al-Boloushi Z, Gómez-Trullén EM, Bellosta-López P, López-Royo MP, Fernández D, Herrero P. Comparing two dry needling interventions for plantar heel pain: a protocol for a randomized controlled trial. J Orthop Surg Res. 2019 Jan 25;14(1):31. 

3.Orhurhu V, Urits I, Orman S, Viswanath O, Abd-Elsayed A. A Systematic Review of Radiofrequency Treatment of the Ankle for the Management of Chronic Foot and Ankle Pain. Curr Pain Headache Rep. 2019 Jan 19;23(1):4.

4.Moroni S, Zwierzina M, Starke V, Moriggl B, Montesi F, Konschake M. Clinical-anatomic mapping of the tarsal tunnel with regard to Baxter's neuropathy in recalcitrant heel pain syndrome: part I. Surg Radiol Anat. 2019 Jan;41(1):29-41. 

5.Kim TH, Lee JK, Sung HK, Kim BH, Song YS, Sung IH. Radiologic features in symptomatic/asymptomatic heels of patients with ankylosing spondylitis. Int J Rheum Dis. 2019 Feb;22(2):222-227.

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