The most common cause of heel pain is plantar fasciitis. Plantar fasciitis (pronounced PLAN-tar fashee-EYE-tiss) is an inflammation of the plantar fascia. “Plantar” means the bottom of the foot; “fascia” is a type of connective tissue, and “itis” means “inflammation”. Heel spurs are soft, bendable deposits of calcium that are the result of tension and inflammation in the plantar fascia attachment to the heel. Heel spurs do not cause pain. They are only evidence (not proof) that a patient may have plantar fasciitis. The plantar fascia encapsulates muscles in the sole of the foot. It supports the arch of the foot by acting as a bowstring to connect the ball of the foot to the heel. When walking and at the moment the heel of the trailing leg begins to lift off the ground, the plantar fascia endures tension that is approximately two times body weight. This moment of maximum tension is increased and “sharpened” (it increases suddenly) if there is lack of flexibility in the calf muscles. A percentage increase in body weight causes the same percentage increase in tension in the fascia. Due to the repetitive nature of walking, plantar fasciitis may be a repetitive stress disorder similar to tennis elbow. Both conditions benefit greatly from rest, ice, and stretching. Surgery is a last resort because 90% get relief with conservative treatment. Causes of heel pain include inadequate flexibility in the calf
muscles, lack of arch support, being overweight, suddenly increasing activity, and spending too much time on the feet.
Dr. Kaplansky, when diagnosing and treating this condition will need an x-ray and sometimes a gait analysis to ascertain the exact cause of this condition. Arch supports, or better yet, custom orthotics are the number one treatment modality for this condition. Physical therapy is another modality that physicians use in the treatment of this condition. Ice packs, muscle stimulants, ultra sound, theraband, cortisone injections and the night splints are also helpful.
If all these conservative measures fail to relieve the pain, then surgery is indicated. The newer minimal incision surgeries such as the Endoscopic plantar fasciotomy surgery are extremely beneficial for this condition.