Overview: Plantar fasciitis is the most common cause of heel pain. The plantar fascia is a band of tissue that extends from the heel to the toes. The band supports the arch of the foot.
Causes: The plantar fascia may be injured by altered biomechanics of the foot (excessive pronation); standing, walking or running on hard surfaces; obesity; improper footwear; and inflexibility of the calf muscle and Achilles tendon.
Symptoms: Pain is typically felt upon the first few steps after being seated or when first getting out of bed.
Treatment: An appropriate home stretching program can make a significant difference. Ice massages to the bottom of the foot may provide relief. Medical massage that focuses on scar tissue breakdown of the leg and foot can be extremely helpful. Platelet-rich fibrin injected into the plantar fascia under ultrasound guidance has been well-studied and proven to be a very effective treatment option for those resistant to more conservative measures.
Overview: Degeneration and inflammation of the Achilles tendon can cause swelling and pain of the middle or lower portion of the tendon.
Causes: This condition is seen commonly in athletes, especially runners with tight calf muscles. A bone spur on the heel can also be a risk factor in developing Achilles tendon pain in the lower portion of the tendon.
Symptoms: Pain and tightness in the tendon are common, with increased pain with walking, running or going up stairs.
Treatment: Anti-inflammatory medications and topical agents can be effective. A walking boot can allow the tendon to rest and reduce pain and inflammation. Physical therapy can help to stretch and strengthen the calf muscles. A local steroid injection into the region can be performed. A safer option is to place platelet-rich fibrin into the injured portion of the tendon to promote healing and reduce inflammation and pain.
Overview: Morton’s neuroma is caused by fibrous tissue formation around a plantar nerve in the intermetatarsal space. The most common nerve affected is located between the second and third toes.
Causes: Irritation, pressure or injury to the plantar nerve can cause Morton’s neuroma.
Symptoms: Numbness or tingling of the affected toes, and a burning pain in the ball of the foot may occur with Morton’s neuroma. Some people also describe the feeling as that of a pebble in the shoe.
Treatment: Initially, conservative approaches such as arch supports and foot pads are used. Injections under ultrasound guidance of either PRF or steroid are both very effective in relieving pain and decreasing inflammation. Surgical intervention can include either decompression of the nerve or removal of the nerve.
Overview: Bursa are fluid-filled sacs that are found in several places within the body. They reduce friction and improve movement. The retrocalcaneal bursa lies between the Achilles tendon and the heel bone.
Causes: Bursa may become irritated and inflamed when excessive stress is placed on them. Direct trauma to the bursa by wearing tight shoes or repetitive minor trauma during certain ankle movements can cause inflammation of the bursa.
Symptoms: Tenderness and pain directly over the back of the ankle and heel are frequent. Local swelling and pain with ankle range of motion may also be seen. Walking, running, jumping or hopping can aggravate symptoms.
Treatment: Oral or topical anti-inflammatory medication can be used to decrease inflammation. Physical therapy can assist in improving biomechanics and providing education. A PRF or steroid injection into the bursa under ultrasound guidance may be pursued. Surgical removal of the bursa is reserved for severe cases of bursitis that have failed more conservative measures.