There are many different causes of pain in the bottom of the heel from problems with the plantar fascia ligament to complicated nerve entrapments (tarsal tunnel syndrome), and heel bone fractures. Plantar fasciitis is the most common cause of heel pain. The plantar fascia acts to support the inside arch of the foot. During normal walking, the plantar fascia will be relaxed and then tightened as body weight is transferred through the foot. With the presence of any of several contributing factors (such as insufficient arch support), inflammation of the plantar fascia as it inserts to the bottom of the heel bone can develop; this is termed “plantar fasciitis” (-itis means inflammation).
Sometimes, small tears in the plantar fascia can occur at or near the insertion of the ligament from the heel bone. Often, the chronic “pulling” of the plantar fascia from the heel bone will stimulate the growth of a heel spur.
Establishing the correct diagnosis is of utmost importance in the successful treatment of heel pain. X-rays are often performed to evaluate for the presence of a heel spur and to rule-out a heel fracture or bone tumor. Diagnostic ultrasound is sometimes used to visualize the plantar fascia, evaluating for tears, scar tissue, or inflammation. Neurosensory testing, a non-painful nerve test, can be used to evaluate a suspicion of localized nerve involvement, helping to direct specific treatment. In the cases of a suspected rupture or large tear in the plantar fascia, or to rule out a stress fracture, an MRI may be performed. The correct diagnosis will ensure that treatment is directed at the actual source of the problem.
Studies have shown that conservative treatments can heal plantar fasciitis about 90 percent of the time. Conservative treatments include stretching, icing, night splints, medications, cortisone injections, physical therapy, and orthotics. Custom-molded orthotics has proven to be a highly successful treatment in the improvement, management, and prevention of plantar fasciitis. If conservative therapies fail after several months, non-invasive shockwave therapy or minimally invasive radiofrequency coblation may be suggested. The University Foot and Ankle Institute are at the forefront of the use of thermal energy radiofrequency procedures also known as Topaz Coblation Surgery in the treatment of plantar fasciitis. This procedure includes the placement of tiny holes in the skin of the heel, placed in grid-like pattern over the area of pain. The radiofrequency probe is then introduced through the skin and placed directly into the plantar fascia. This treatment has shown to increase healing growth factors and blood flow to the area of chronic scar tissue within the plantar fascia. This procedure requires minimal downtime, allows a rapid return to activity, and minimizes some of the long-term risks associated with an open surgical release of the plantar fascia. In cases where surgery is indicated, the doctors utilize the Endoscopic Plantar Fasciotomy technique.
The University Foot and Ankle Institute is a world leader in the research & treatment of heel pain, offering complete diagnostic services, non-surgical and state-of-the-art surgical techniques in the treatment of plantar fasciitis and other sources of heel pain. The Institute has been at the forefront of innovative diagnostic tools as well as new minimally invasive surgical and non-surgical techniques.