What is Plantar Fasciitis?

Heel pain is one of the leading problems that causes patients to

visit a podiatrist. Plantar fasciitis (or heel pain) is commonly traced to an inflammation on the bottom of the foot.

Plantar fasciitis is caused by inflammation of the connective tissue that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Also called “heel spur syndrome,” the condition can usually be successfully treated with conservative measures such as use of oral and topical anti-inflammatory medications and ice packs, stretching exercises, orthotic devices, and physical therapy.

The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.

The symptoms of plantar fasciitis are:
Pain on the bottom of the heel
Pain that is usually worse upon arising
Pain that increases over a period of months

If heel pain is not too severe as to cause debilitation, conservative forms of treatment may be all that is required. Most patients with plantar fasciitis notice relief after a few weeks of conservative care.  Conservative therapy consists of oral and topical anti-inflammatory medications, ice, physical therapy, and the use of orthotics.  In most cases, these simple measures combined with wearing comfortable shoes helps to get rid of  heel pain.   Doctors may also prescribe a night splint to help stretch the plantar fasica ligament.When the pain becomes debilitating, the doctor may decide to administer a series of injections (corticosteroid). 

If all conservative options have been exhausted and there is still heel pain present, surgical interventions may be warranted.

Heel pain can manifest in a few ways.  Plantar fasciitis is pain on the bottom of the heel; achilles tendonitis is pain at the back of the heel.  Typically, both conditions elicit some type of heel pain and both can usually be effectively treated with conservative care.

What is Achilles tendinitis?

Achilles tendinitis is an inflammation of the surrounding sheath (paratenonitis), degeneration within the substance of the tendon (tendinosis) or a combination of the two. ​

The exact causes are not completely understood.  There is a correlation with a recent increase in the intensity of an exercise program. It can be associated with repetitive activities which overload the tendon structure, postural problems such as flatfoot or high-arched foot, or footwear.  It can also be due to the aging process.

Symptoms typically start gradually and spontaneously. Aching and burning pain is noted to back of the heel, especially with morning activity. It may improve slightly with initial activity, but becomes worse with further activity. It is aggravated by exercise. Over time less exercise is required to cause the pain.

The Achilles tendon is often enlarged, warm and tender to touch.  

Most cases are successfully treated non-surgically although this is time-consuming and frustrating for active patients. Treatment is less likely to be successful if symptoms have been present more than six months. Nonsurgical management includes nonsteroidal anti-inflammatory medications, rest, immobilization, limitation of activity, ice, stretching and heel lifts or custom orthotics. 

If all conservative options have been exhausted and there is still heel pain, surgical intervention may be warranted.