The most common cause of pain on the bottom of the heel is plantar fasciitis. Patients with this condition often complain of heel pain the first thing in the morning or after getting up to stand after sitting. The pain can be a sharp, searing pain or present as a tearing feeling in the bottom of the heel.
The plantar fascia is a thick ligament that runs from the bottom of the heel and fans out into the ball of the foot, attaching into the base of the toes. The ligament is made of dense, fibrous connective tissue that will stretch very little. It acts something like a shock absorber. As the foot impacts the ground with each step, it flattens out, lengthening the foot. This action pulls on the plantar fascia, which stretches slightly. When the heel comes off the ground the tension on the ligament is released. Anything that causes the foot to flatten excessively will cause the plantar fascia to stretch greater that it is accustom to doing. One consequence of this is the development of small tears where the ligament attaches into the heel bone. When these small tears occur, a very small amount of bleeding occurs and the tension of the plantar fascia on the heel bone causes a spur on the bottom of the heel to form. Pain experienced in the bottom of the heel is not produced by the presence of the spur however. Many people have heel spurs at the attachment of the plantar fascia without having any symptoms or pain.
There are several factors that cause the foot to flatten and excessively stretch the plantar fascia. The primary factor is the structure of a joint complex below the ankle joint, called the subtalar joint. The movement of this joint complex causes the arch of the foot to flatten (pronation). If there is excessive pronation of the foot during walking and standing, the plantar fascia is strained. Over time, this will cause a weakening of the ligament where it attaches into the heel bone, causing pain. When a person is at rest and off of their feet, the plantar fascia attempts to mend itself. Then, with the first few steps the fascia re-tears, causing pain. Generally, after the first few steps the pain diminishes. This is why the heel pain tends to be worse the first few steps in the morning or after rest.
Another factor that contributes to the flattening of the arch of the foot is tightness of the achilles tendon. When the tendon is tight, it limits the movement of the ankle joint which forces the subtalar joint to pronate excessively. Excessive subtalar joint pronation then causes excessive tension on the plantar fascia. Tightness of the achilles tendon can be a result of several different factors including inactivity or prolonged rest, wearing high heels or western style cowboy boots, or simply a genetic predisposition.
What we can do to help you solve this problem
If you have pain in your heel, we would recommend that you make an appointment to see us before the pain becomes chronic.
Initially, we will perform a complete and thorough examination of your foot structure. We will also perform a comprehensive biomechanical examination to see what role your foot function contributes to your condition. Digital x-rays are often taken to look for things such as a heel spur or stress fracture.
Every case of plantar fasciitis can be different and we will help determine the exact cause of your pain. We will help educate you on things such as proper shoe choices and certain activities to avoid. To help reduce the inflammation associated with plantar fasciitis, we may recommend a cortisone injection or an anti-inflammatory medication. Plantar fasciitis night splints are also something that we have available that can help you with your pain.
The most important thing that we can do for you, though, is to fit you with the proper arch support or prescription orthotics. If your plantar fasciitis is mild, we may be able to use a pre-made arch support to control the abnormal flattening of your arch. We carry arch supports in our office that are typically much better than what you will find in the store. Some cases of plantar fasciitis are more severe and may require the use of a prescription orthotic. This is a custom-made arch support that is made from a plaster impression or digital scan of your foot and arch. Unlike pre-made arch supports, however, an orthotic completely controls abnormal pronation or flattening of the arch. Read more about custom orthotics.
Fortunately, most cases of plantar fasciitis get better with conservative therapy. If the condition becomes chronic, however, we sometimes may need to perform surgery to relieve your pain. An endoscopic plantar fasciotomy (EPF) is a procedure performed to release a small portion of the plantar fascia from the insertion into the heel bone. The release causes your body to start a healing process of the fascia to help you get back on the road to recovery. Click here to learn more about this procedure.
At Council Bluffs Foot & Ankle Care, our physicians have many years of experience in treating this painful condition. If you suffer from heel pain, it is important to seek professional treatment so you can start living your life pain-free again.