Heel Pain: Heal!
Amie C. Scantlin, DPM, MS, FACFAS
Glencoe Regional Health Services
(320) 864-3121 ext. 1933
www.grhsonline.org
Important Notice
The information contained in this document is for informational purposes only. It is not
intended to diagnose or treat specific patients and should not be used as a substitute
for the medical care and advice of your health care provider. In addition, this
document may contain references to specific products and/or medications. Such
references, whether by brand name or generically, are provided for informational
purposes only and do constitute endorsement, recommendation, or approval by
GRHS or its medical providers. Always consult a medical professional if you have
concerns regarding your health. If you are experiencing a medical emergency, dial
911.
**Due to copyright and the graphic nature of the images used in this presentation,
many images have been removed from the original presentation. If you would like a
copy of the original slides, please contact the events coordinator at 320-864-7810.
Heel Pain:
Your Feet Don’t Have to
Feel 100 Years Old!!
Symptoms
• Severe pain in the heel or arch when
getting out of bed in the morning
(I feel like I’m 100 years old!!)
• Pain improves with walking
• Pain can return after periods of rest
• Feels like a “stone bruise”
Plantar Fasciitis
• Inflammation and pain along the
plantar fascia - the tissue band
that supports the arch on the
bottom of the foot
• Usually on the bottom of the
heel at the point where the
plantar fascia attaches to the
heel bone
Plantar Fasciitis
• Becomes chronic in 5-10% of all patients
• Is not necessarily associated with a heel
spur
• Over 95% resolve with conservative
treatment
More Plantar Fasciitis Symptoms
• Radiating pain to
the arch and/or
toes
• May be caused
from flat shoes or
shoes with no
support
Even More Plantar Fasciitis
Symptoms
• In later stages, pain may persist/progress
throughout the day
• Pain varies in character: dull aching,
“bruised” feeling.
• Burning or tingling, numbness, or sharp
pain may indicate local nerve irritation
Plantar Fasciitis Risk Factors
• Biomechanical
abnormalities
• Overly tight calf
muscle
• Poor shoe choices
• Weight gain
• Barefoot walking
• Work surface
Plantar Fasciitis: Evaluation
• Pain with pressure on
bottom of heel or arch
• Limping
• Foot Type: low vs.
high arch, pronation
Plantar Fasciitis: Diagnosis
• X-ray findings – Spur?
Other abnormalities?
• Ultrasound
• Nerve Conduction
Velocity studies to
evaluate potential nerve
problems
• MRI – rarely used.
Mostly for chronic,
unresponsive cases
Plantar Fasciitis Treatment
• Mechanical –
treat the cause
• Anti-inflammatory –
treat the pain
• Neither done in
isolation
• Adjust exercise
regimen
Exercise Modification
• Cease all high impact activities
– Walking on treadmill
– Walking on cement/ track
• Begin low impact exercises
– Swimming
– Stationary bike
– Elliptical machine
• Slowly return to intensity and mileage
Plantar Fasciitis Treatment
• Stretching, shoe
modifications, avoid walking
barefoot
• Icing and rest
• Night or resting splint
• Supplemental arch support
(OTC vs. custom orthotics)
Orthotic Therapy
• Custom-molded arch
support
• Takes tension off
plantar fascial band
• Proven effective
treatment for acute
and chronic heel pain
Additional Treatment Options
• Anti-inflammatory medication
• Physical therapy, including stretching
and massage
• If conservative measures fail, surgery is an
option
Heel Spur Syndrome
• Pain associated with a spur on the bottom
of the heel
• Close cousin of plantar fasciitis
• Pain often caused from size of the spur
alone
• Treatment is exactly same as plantar
fasciitis initially with addition of injection
therapy
Other Potential Causes of
Heel Pain
•
•
•
•
•
•
•
Calcaneal apophysitis (children)
Arthritis
Stress fracture
Achilles tendon problems
Bone cyst
Pinched nerve/Nerve entrapment
Low back or disk problems
Other options for heel pain
• Over 95% of heel pain patients respond to
initial therapies within a relatively short
period of time
• For unresponsive cases, options include:
– Work-up for spinal impingement including Lumbar
spine MRI
– Surgical procedures, open or endoscopic
– Rule out other causes of heel pain including tarsal
tunnel syndrome
Tarsal Tunnel Syndrome
• Similar to Carpal Tunnel
Syndrome in the wrist
• Impingement of the
posterior tibial nerve
along its course into the
foot
• Mimics heel spur
syndrome/ plantar
fasciitis
• Patients are
unresponsive to heel pain
treatments
Surgical Options
• Plantar
Fascial
Release
vs.
• Removal of
Heel Spur
Plantar Fascial Release
• Purpose is to release
band from attachment
to heel bone or
calcaneus
Heel Spur Resection with Plantar
Fascial Release
• Reduction of the spur
• Concomitant release
of plantar fascial band
Video
• http://www.youtube.com/watch?v=ziepku2
BKy4&feature=player_embedded
Conclusion
• Heel pain occurs frequently in men and
women
• Resolves in 95% of cases
• Early treatment is important
• Be good to your feet!
Visit Dr. Scantlin!
• For more information on heel pain, or for a
diagnosis, contact your podiatrist:
Amie Scantlin, DPM, MS, FACFAS
Glencoe Regional Health Services
Glencoe Clinic
(320)864-3121 ext.1933
Thank you for coming today!