Plantar fasciitis

Most commonly, heel pain is caused by plantar fasciitis, an inflammation of the fibrous tissue (plantar fascia) along the bottom of your foot that connects your heel bone (calcaneus) to your toes.

The plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. However, if tension on that bowstring becomes too great, minute tears can occur along with inflammation. The result is a stabbing or burning pain that's usually worse in the morning because the fascia tightens (contracts) overnight. Once your foot limbers up, the pain generally decreases, but it may return after long periods of standing or after getting up from a seated position. In severe instances, your foot may hurt with the slightest pressure, making walking difficult. Sometimes, plantar fasciitis is also associated with a growth (bone spur) that develops from tension on your heel bone.

Treatment

If self-care techniques don't help, you doctor might suggest other treatments to heal your heel.

Conservative treatment
Nonsurgical treatments that may promote healing include:

• Night splints. Your doctor may recommend wearing a splint fitted to your calf and foot while you sleep. This holds the plantar fascia and Achilles tendon in a fixed position overnight so that they can be stretched more effectively.

• Orthotics. Your doctor may prescribe custom-fitted shoe inserts (orthotics), which are specially molded to your feet, to help distribute pressure to your feet more evenly. These are generally recommended if over-the-counter shoe inserts don't work.

• Over-the-counter medications. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others), naproxen (Aleve) and others may ease pain and inflammation, although they won't treat the underlying problem. Use as directed, tapering off as your pain decreases.

• Physical therapy. A physical therapist can devise a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist may also teach you to apply athletic taping to support the bottom of your foot.

Surgical or other procedures
If conservative treatment doesn't provide relief, you might consider:

• Corticosteroids. When other steps fail, your doctor may suggest one or two injections of corticosteroid medication in your heel for temporary relief. Multiple injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. Another effective method for delivering corticosteroid medication is a technique known as iontophoresis, which uses gentle electric current to draw the medicine into the area of discomfort. This technique requires six to nine sessions, lasting 15 to 20 minutes each, but avoids the complications associated with injections.

• Deep heat. The vibrations generated by ultrasound technology provide deep heat that can increase blood flow and promote healing. The plantar fascia has a relatively poor blood supply, so any way to increase blood flow to the tissue may help.

• Extracorporeal shock wave therapy. This noninvasive surgical procedure, which is relatively new, uses strong sound waves directed at the area of heel pain to treat chronic plantar fasciitis that hasn't responded to six months of more conservative treatments. It's an outpatient treatment that takes about 30 minutes and may be performed under local anesthesia, although studies show that low-energy machines, which don't require anesthesia, can achieve similar benefits. You should be able to return to work the next day but may need to avoid athletic activities and lifting heavy objects for a few weeks.

Complications may include bruising of your skin, swelling, pain, numbness or tingling, and rupture of the plantar fascia. This therapy isn't used for children, pregnant women or patients with a history of bleeding problems.

• Surgery. Surgery to detach the plantar fascia from the heel bone (plantar fasciotomy) is rarely necessary. It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.