Heel pain due to Plantar fasciitis (Joggers Heel)

What is the cause of plantar fasciitis?

Plantar fasciitis is caused by damage or irritation of plantar fascia. The pain is usually felt under the heel near where plantar fascia attaches to the heel bone. In most cases a specific cause or reason is not known but the following factors can predispose one to the development of this condition.  

• Being overweight or obese

• Standing a lot, especially on a hard surface

• Starting / doing more activity or high impact activity like running/sports (especially on hard surfaces /courts)

• Tight muscles of calf

• Flat foot or high arched foot

What are the symptoms in a case of plantar fasciitis?

People who are 40 to 60 years old are more likely to have plantar fasciitis, but it can affect anyone. Women have a higher chance of getting it than men.

Some of the common symptoms of plantar fasciitis are:

• A sharp, burning, or sore feeling on the heel or the bottom of the foot.

• Feeling pain when you start walking in the morning or after resting for a while. The pain usually goes away after walking for a few minutes.

How to diagnose plantar fasciitis?

The doctor makes the diagnosis based on the patient’s history and what they find on examination. An ultrasound scan done in the clinic can also help to verify the diagnosis.

X rays are used to rule out reasons for heel pain, such as broken bones or arthritis. Heel spurs (a small piece of bone that can stick out from the bottom of the heel bone) can often be seen on an x-ray. About 3 out of 10 people have a heel spur, but not many of them have heel pain.

Sometimes, the doctor may ask for a magnetic resonance imaging (MRI) scan to confirm the diagnosis and rule out other problems that may look similar.

What is treatment of plantar fasciitis?

Plantar fasciitis usually gets better on its own, according to the literature. Most patients will see improvement within 10-12 months, but it can be very painful and affect the quality of life. Some of the treatment options are:

Activity modification: Resting or changing the activities that cause more pain, such as running or step aerobics on hard surfaces.

Ice: You can roll your foot over a cold-water bottle or ice to help. You can also wrap ice in a towel and put it on the painful area. Do these 3 to 4 times a day. Don’t use ice for too long or directly on the skin, as it can damage the skin.

Nonsteroidal anti-inflammatory drugs: Medicines like ibuprofen or naproxen can help with pain and inflammation. Follow your doctor’s advice on how to use them.

Exercise: Plantar fasciitis can get worse if your feet and calf muscles are tight. Stretching the plantar fascia and the calf muscles every day can help ease the pain. Night splints can also help by gently stretching the plantar fascia while you sleep. They may take some time to work, and some people may find them uncomfortable. Sometimes, wearing them for 30 minutes before getting out of bed in the morning can help with the first steps of the day.

Weight management – keeping a healthy body weight can help by lowering the pressure on the plantar fascia.

Supportive shoes and orthotics can help by cushioning the heel and reducing the irritation, especially for people with flat feet. Don’t walk barefoot and wear shoes with a firm outer sole and a soft insole. Custom made orthotics may be more comfortable, but there is no strong proof that they work better.

Extracorporeal shockwave therapy (ESWT)– this is a treatment option for runners, as it may work well for them.

Cortisone/ Steroid Injections – this is a common treatment option for patients who don’t get better with simple measures. There is some evidence that these injections can help in the short term. They should be done under ultrasound guidance to make sure they are accurate. Using low doses of steroid can help avoid possible side effects. You may be told to avoid running and other high impact activities for about 2 weeks after the injection.

Growth factor injections. Platelets are part of the blood. They help with clotting and have growth factors that help with healing. Growth factors are isolated from your own blood by spinning it in a machine to separate the platelets. The growth factors from the platelets can speed up the healing process, using your body’s natural ability. These injections should be done under ultrasound guidance and may give lasting relief.

Dr. Chinmoy Roy is a respected pain expert and author of multiple medical books. He is available at Rajarhat Pain Clinic, Newtown, Kolkata. He is an expert of ultrasound guided pain procedures.