Heel pain is most often caused by plantar fasciitis, a condition that is sometimes called heel spur syndrome when a spur is present. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome. Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel bone to the toes. The fascia first becomes irritated and then inflamed, resulting in heel pain. 90 % of the time plantar fasciitis does not require surgery and can be treated by conservative therapy. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or rarely a bone tumor. Because there are several potential causes, it is important to have heel pain properly diagnosed.
The most common cause of plantar fasciitis relates to biomechanic of the foot. People who have problem with their arches, either overly flat feet or high-arched feet, and obesity are more prone to developing plantar fasciitis.
The symptoms of plantar fasciitis are: pain on the bottom of the heel. Pain that increases over a period of months. People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet. Plantar fasciitis diagnosis is based on medical history and clinical examination. In addition, diagnostic imaging studies such as x-rays or other imaging modalities such as a MRI or CT scan can be utilized to rule out other pathologies.
Conservative therapy of plantar fasciitis includes: Stretching exercises, avoid going barefoot, icing, limit activities, shoe modifications, medications(NSAIDS), padding, strapping , custom orthotic devices, injection therapy, removable walking boot, brace and physical therapy. PRP injection is a new approach.
Surgery is only needed in a small amount of patients but when conservative therapy has failed.
There are numerous surgical procedures, these procedure includes: Minimal Invasive surgery (endoscopic plantar fascia release or small incision approach or percutatanous coblation of the fascia ) or the traditional open approach.