The most common cause of heel pain is plantar fascitis. The plantar fascia is the ligament that connects your heel bone to your toes, and one of its primary functions is to support the arch of your foot. This ligament can become strained if your feet roll inward too much when you walk (called excessive pronation), if you have flat feet or high arches, are overweight, if you stand, walk, or run on hard surfaces for long periods of time, or if you wear worn-out or poorly fitting shoes. When any of these circumstances strain your plantar fascia, it becomes weak, swollen, and inflamed, and soon thereafter the bottom of your heel and/or entire foot hurts when you stand or walk.
Because the pain of plantar fascitis has unique characteristics — pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas – in addition to a diagnosis based on a physical exam, your doctor may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing your pain.
Most doctors recommend that initial treatment for plantar fasciitis should be quite conservative and include care and treatments such as limiting running exercises, using a heel cushion, applying ice packs, stretching, taking non-steroidal anti-inflammatory drugs, applying a night splint, steroid injections under very tight medical control, controlling your weight, wearing comfortable and supportive shoes, receiving ultrasound treatments, and utilizing customized orthotics to help cushion your heels. Rather routine cases of alleviating this condition usually take up to 12 weeks with some lingering pain, but about 1 in 20 patients will need surgery.
The patients under Dr. Alex’s care who have fared the best are the ones who have lost weight, limited their walking and/or standing time, ensured that they always wear comfortable shoes (by the way, wearing slippers or sandals in lieu of shoes or going barefoot worsens this condition as the feet receive no support), applied ice packs, underwent appropriate number of ultrasound treatments, and used their custom-made orthotics in all the shoes they wore.