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Plantar heel Pain- Plantar Fasciitis
What is plantar fasciitis
Plantar fasciitis is a common cause of heel pain. Plantar fasciitis is an inflammation of a band of tissue that extends from the heel to toes. The plantar fascia provides stability to the foot and the arch by helping prevent complete collapse of the arch when weight bearing. Irritation and constant overstretching of the plantar fascia results in inflammation and pain in the bottom of the heel.
Causes
The most common cause of plantar fasciitis relates to faulty structure of the foot. People with arch problems, whether flat feet or high arched feet, are more prone to developing plantar fasciitis. Other causes included nonsupportive footwear, minor trauma like a misstep, or unusual increase in activity. Pain then develops as weight bearing continues on the affected foot. Due to the inability to stay off the foot for an extended period of time to allow healing to occur, the acute inflammation becomes chronic as the acute inflammatory process is continually disrupted. This causes the deep aching pain that persists.
Symptoms
- Pain in the bottom of the heel
- Pain in the arch
- Pain with 1st step in the morning or 1ststep after being seated for an extended period of time
- Swelling
Treatment
Non-surgical
- Stretching
- Activity modification
- Shoe modifications
- Medication
- Injection
- Physical Therapy
- Padding/taping
- Orthotics
- Night splint
Surgical
Surgical treatment includes breaking up of the scar tissue within the plantar fascia or cutting of some of the plantar fascia. There are various ways to do so, some of which include:
Posterior Heel Pain- Haglund's/Retrocalcaneal Exostosis
What is A HAGLUND'S DEFORMITY/RETROCALCANEAL EXOSTOSIS
Haglund’s Deformity is a bony enlargement at the top of the back of the heel. The bony prominence presses up against the Achilles tendon and shoes can cause rubbing against the achilles tendon and bony prominence. This can lead to painful bursitis, which is inflammation of the bursa (flui-dilled sac between the tendon and bone)
A retrocalcaneal exostosis is a bony prominence also in the back of the heel but lower in the back of the heel where the Achilles tendon attaches to the bone. The Achilles tendon, bone interface becomes calcified and a bone spur can form, causing irritation in shoes and when the Achilles tendon pulls on the heel bone.
Although technically two separate issues, Haglund’s deformity and a retrocalcaneal exostosis occurs in the same region of the heal and is diagnosed and treated similarly.
Causes
Haglund’s deformity is caused by a tight achilles tendon or a high arched foot which can be hereditary
A retrocalcaneal exostosis is caused by a tight achilles tendon which leads to achilles tendinitis at its insertion to the heel bone causing calcification of the tendon in the area which over time turns into bone.
Symptoms
- Noticeable bump in the back of the heel
- Pain at the bump and along the achilles tendon in the area of the bump
- Swelling in the back of the heel
- Redness near the inflamed tissue
- Tight achilles tendon
Treatment
Non-surgical
- Medication- NSAIDs, steroids
- Exercise/stretching
- Heel lifts
- Heel pads
- Shoe modifications
- Physical therapy
- Orthotics
Surgical
Surgery often involves removal of the prominent bone with or without debridement of the Achilles tendon either with an open or minimally invasive approach. Platelet Rich Plasma (PRP) can be injected into the area to promote healing.