Heel Pain/Plantar Fasciitis
What is heel pain or plantar fasciitis?
Definition:
Plantar fasciitis is the most common cause of heel pain, resulting from inflammation or microtearing of the plantar fascia—a thick band of connective tissue that supports the arch and runs from the heel to the toes.
Etiology & Risk Factors:
- Overuse or repetitive strain (especially in runners, athletes, or those on their feet for long hours)
- Flat feet or high arches
- Tight Achilles tendon
- Obesity (increased mechanical load)
- Improper footwear (poor arch support or cushioning)
- Sudden increase in activity
Symptoms:
- Sharp heel pain, typically worst:
- First steps in the morning
- After prolonged rest or standing
- After activity (not usually during)
- Tenderness along the medial plantar aspect of the heel
- Pain may decrease with movement but worsens after inactivity
Diagnosis:
- Primarily clinical, based on history and physical exam
- Imaging:
- X-ray: to rule out heel spurs or fractures
- Ultrasound: may show thickened fascia
- MRI: used in complex or refractory cases
Treatment:
Conservative (first-line):
- Rest and activity modification
- Ice therapy Fitomo Ankle Ice Pack Wrap, Icing Plantar Fasciitis Relief (Ice/Fascia Release/Accupressure)
- Stretching exercises (plantar fascia and calf) - ProStretch (The Original Calf Stretcher & Foot Rocker!)
- Orthotics or heel cups
- Night splint1 / Night splint2 / Night splint3
- NSAIDs (non-steroidal anti-inflammatory drugs)
- Physical therapy
Advanced/Adjunctive options:
- Corticosteroid injections (limited use due to risk of fascia rupture)
- Extracorporeal shock wave therapy (ESWT)
- Platelet-rich plasma (PRP) injections
- Tenex or other percutaneous fasciotomy procedures
Surgical:
- Reserved for recalcitrant cases (lasting >6–12 months)
- Options include partial plantar fasciotomy or gastrocnemius recession
Prognosis:
- Excellent with conservative management
- Most cases resolve in 6–12 months
- Early intervention improves outcomes
