age is really just a number

There is an epidemic of heel pain in the United States. If you have feet, you have probably had heel pain at some point. It can feel like sharp, aching pain or stiffness on the bottom of one or both heels. The pain is usually worse upon waking in the morning or after sitting down for a long period of time. This can be incredibly painful and cause you to limp for several minutes until it warms up. 

Heel pain is most common in people who stand or walk a lot at work or wear unsupportive shoe gear; or weekend warrior athletes like marathon runners and soccer players. Fatigued and unsupportive shoes are the major culprits I see that are usually the precipitating cause of heel pain.

The most common cause of heel pain is plantar fasciitis which is irritation of the ligament that holds up your arch. If left untreated, plantar fasciitis can become plantar fasciosis. 

Heel pain, whether plantar fasciitis or plantar fasciosis, is a common foot problem that responds best to a stepwise clinical protocol approach to treatment.

Plantar Fasciitis vs. Plantar Fasciosis

Plantar Fasciitis is heel pain that has been present for less than 6 months and is an acute inflammatory injury involving the plantar fascia (the ligament that holds up your arch and attaches to the heel bone). This responds well to anti-inflammatory treatments. Aggressive successful treatment of plantar fasciitis usually resolves heel pain in 6-8weeks.

Plantar Fasciosis is heel pain that has been present for more than 6 months and is characterized by a lack of inflammation and an exceptional amount of scar tissue and fibrosis. The body’s response to chronic inflammation is actually to give up and decrease the healing blood supply necessary for resolution. Successful treatment of plantar fasciosis requires irritation of the tissue, breakup of the scar tissue and in fact are-injury of the area so that it transforms back to plantar fasciitis. Treatment of fasciosis needs to be aggressive and resolution can take up to 4-6 months

Conservative Treatment: Step 1 (4-6 weeks) 

• Icing the area 3-4 times a day for 12-15 minutes
• Oral anti-inflammatories
• Steroid injections (if needed)(no more than 3 in one year)
• Stretching exercises (see video)
• Shoe gear recommendations (click here for recommendations)
• Prefabricated orthotics (click here for recommendations)
• Night splint (click here for an example)
• Relative rest

Conservative Treatment: Step 2 (next 6-12 weeks) 

• Custom functional orthotics (click here to make an appointment)
• Rest (may require a walking cast)
• EPAT therapy (in-office procedure)
• Physical Therapy (6-12 weeks)

Surgical Treatment: Step 3 (after 4-6 months of treatment) 

• EPF (endoscopic plantar fascial release)
• Open plantar fascial release with heel spur resection

85% of patients get better with conservative treatment! Diligence and Consistency of treatment is the key!