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Heel Pain (Plantar Fasciitis)

Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation or, rarely, a cyst.

Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is able to distinguish between all the possibilities and to determine the underlying source of your heel pain.

What Is Plantar Fasciitis?Heel pain is often caused by plantar fasciitis

Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.


The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.

Wearing nonsupportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity and overuse may also contribute to plantar fasciitis.


The symptoms of plantar fasciitis are:

  • Pain on the bottom of the heel
  • Pain in the arch of the foot
  • Pain that is usually worse upon arising
  • Pain that increases over a period of months
  • Swelling on the bottom of the heel

People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they have been sitting for long periods of time. After a few minutes of walking, the pain decreases because walking stretches the fascia. For some people, the pain subsides but returns after spending long periods of time on their feet.


To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process, the surgeon rules out all possible causes for your heel pain other than plantar fasciitis.

In addition, diagnostic imaging studies, such as x-rays or other imaging modalities, may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Nonsurgical Treatment

Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:

  • Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
  • Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
  • Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.
  • Limit activities. Cut down on extended physical activities to give your heel a rest.
  • Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
  • Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches:

  • Padding, taping and strapping. Placing pads in the shoe softens the impact of walking. Taping and strapping help support the foot and reduce strain on the fascia.
  • Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
  • Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
  • Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
  • Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
  • Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.


Field Sports Injuries on the Rise for Children

Overuse and lack of proper equipment elevates risk for pain and injury

Foot and Ankle Injuries in Young Athletes Infographic

Summertime brings longer days and, for many children, lots of outdoor activity. The American College of Foot and Ankle Surgeons (ACFAS) reminds parents and coaches that increased participation in outdoor sports can also increase the number of foot and ankle injuries, particularly for children who play field sports.

Ankle sprains alone account for 10 percent of all injuries seen in emergency departments. ACFAS calls for parents and coaches to educate themselves on the signs of foot and ankle injuries and to seek treatment early. Among the most popular summer recreational activities are field sports, such as flag football, lacrosse, field hockey, soccer, baseball and softball—sports that often require the use of rubber-molded cleats and, in some cases, metal screw-on spikes.

“Children under the age of 10 are at special risk for sports injuries, especially when cleats are involved,” said Timothy Swartz, DPM, FACFAS, a Maryland-based foot and ankle surgeon and Fellow member of the American College of Foot and Ankle Surgeons. “Aside from creating imbalances that could result in ankle sprains, continuous running in a cleated shoe can injure and inflame the growth plate in the heel, causing a painful condition called Calcaneal Apophysitis, which can be extremely slow to heal and, in extreme cases, may require surgical intervention.”

Overuse injuries, such as stress fractures, are also a major risk factor for younger athletes whose bones are still growing. ACFAS advises parents and coaches to be alert to a child limping on and off the field and to never encourage children to play through pain. Parents should watch for symptoms of common sport injuries, including pain during normal activity, swelling, bruising, and in more serious cases, tissue tears.


Why Women’s Feet Hurt More in Autumn

Fall is not a fun time of year for women like Elaine Powers.

In the summer months, “like everybody else, I like to wear flip-flop sandals, open-toed shoes, a nice pedicure with good nail polish,” she says.

But as autumn arrives, the 49-year-old South Carolina hospice nurse is making the annual changeover to closed-in shoe styles more appropriate to the cooler weather. It’s a transition many women are making in their wardrobes. But it’s more painful for women like Powers, and not because she’s a slave to foot fashion. Powers has bunions.

“Even after you take your shoes off or put your feet up, it’s just a throbbing. It’s almost like every time your heart beats, that bunion throbs,” she says.

Women with bunions are a common sight in the waiting rooms of many foot and ankle surgeons during this time of year.

St. Louis foot and ankle surgeon Karl Collins, DPM, FACFAS, gives two additional reasons for this annual trend. One is financial. Women are closer to meeting insurance deductibles near the end of the year.

“The other thing is people are very active in the summer,” Collins says. “They’re always outdoors, they’re always at the pool or whatever, so they will decide to get their bunion fixed in the winter because, in their mind, they’re not missing anything fun.”

Powers has suffered with bunion pain for nearly 25 years. However, many women never experience pain from their bunions, even when the deformity looks severe. Shoes do not cause bunions, but they may cause bunion pain. That’s why foot and ankle surgeons recommend shoe modifications to new patients. Avoiding high-heeled shoes and styles that crowd the toes together can help. Collins says proper shoe selection and adjustment can go a long way.

“If they have a shoe that fits well everywhere else, but there’s just a little bit of irritation at that one spot, we may recommend that they have the shoe modified (by a shoe repair shop),” he says.

South Carolina foot and ankle surgeon Michelle L. Butterworth, DPM, FACFAS, treats a lot of teachers with back-to-school bunion pain. She says many women don’t understand what doctors mean about shoe width: It’s the front of the shoe that needs to be wide.

“Anything that’s real pointy will put more pressure on that (bunion) bump,” she explains.

In addition to recommending shoe changes, foot and ankle surgeons may also prescribe foam- or gel-filled padding, orthotics, anti-inflammatory medications and injections for bursitis, nerve irritation and joint irritation. While these techniques address pain, they do not stop the bunion from getting worse. Only surgery can correct the deformity.

Bunion surgery boasts a high success rate. But surgeons agree that patients need to understand what their procedure and recovery will involve.

“Probably the biggest thing is they think surgery won’t work and (the bunion is) going to come back,” says Butterworth. “It’s probably the biggest myth I dispel.”

Powers is one of her patients.

“That’s one of the reasons why I haven’t had this surgery before now,” Powers says. “A lot of people tell me once you have (bunions), you are always prone to have them, they’ll come back.”

Following the surgeon’s instructions for recovery can significantly reduce the chances of a bunion returning.

“If wearing four-inch heels and working on your feet all day wasn’t good for you before the surgery, it’s certainly not going to be good for you after the surgery,” notes Michael Loshigian, DPM, FACFAS, a New York City foot and ankle surgeon.

Powers hasn’t made up her mind about bunion surgery. She’s already tried prescription pain medication and struggles to find comfortable shoes. This fall, Butterworth will perform bunion surgery on Powers’ 19-year-old daughter, who inherited her mother’s feet. Powers wants to see how that turns out. She also has to worry about finding someone to cover her 12-hour work shifts for several weeks.

But if she chooses surgery, she already knows how she’ll celebrate after her recovery.

“I’m buying a pair of stiletto heels, and I’m wearing them everywhere I go,” she jokes.



Simple Precautions Can Keep You on the Trails This Fall

Even the most avid outdoor enthusiasts don’t realize just how much stress and strain they put on their feet and ankles during autumn hikes. Those long, vigorous walks on uneven terrain may be fun, but without proper care, they could lead to damage to their feet and ankles.

Poor choice in footwear and lack of conditioning can lead to foot and ankle injuries that will keep you from participating in the sports you love. Follow these precautions and you can enjoy all the season has to offer.

Wear the Right Shoes & Socks

You don’t wear hiking boots to play basketball, so practice the same common sense in return. Hikers should wear top-quality, well insulated, moisture-proof hiking boots with steel or graphite shanks. These boots offer ankle support and reduce muscle and tendon fatigue and injury risk.

Proper socks can also mean the difference between comfortable walks and those resulting in blisters, fungal infections and even frostbite. To prevent these problems, always wear two layers of socks:

  • Layer 1: Synthetic socks to keep your feet dry and reduce blister-causing friction.
  • Layer 2: Wool socks to add warmth, absorb moisture away from your skin and make the hiking boot more comfortable.

Start Slow

“No pain, no gain” does not apply to your feet and ankles, so play it smart and ease into your outdoor adventures. Start with less difficult terrain or shorter walks. Poor physical conditioning is the leading cause of injuries, so stretching exercises and building up of foot and ankle muscles can prevent these problems.

Don’t do more than your body can take—an injury on your first time out could mean your last time out for the season!

Listen to Your Body

Pain is the body’s way of telling you something is wrong. If your feet or ankles start to hurt, take a break. Pushing yourself to “hike on” through even minor pain can lead to more serious injuries.

If you injure your feet or ankles when out on a hike, contact a foot and ankle surgeon right away. Early treatment can get you back on the trails in no time.