Heel pain is one of the most common foot problems seen in an orthopaedic practice. A specialized fat-pad is located beneath the skin and the heel bone, and this fat-pad has hard fibrous septi that essentially creates a "bubble-pack" for shock absorption. The plantar fascia is a thickening of tissue on the bottom of the foot which inserts into the heel bone. A heel spur or calcification can occur near the attachment of the plantar fascia; however, this spur is not the cause of pain. Heel pain is usually caused by inflammation or degeneration of the plantar fascia near its insertion into the bone.
The majority of patients heel pain is, therefore, caused by plantar fasciitis or inflammation of the plantar fascia. An overuse syndrome is the most common cause of plantar fasciitis and this occurs in active individuals such as fitness walkers, runners, and hikers. It is also seen in over-weight patients who start a exercise program in an effort to lose weight. The most difficult cases occur in heavy individuals whose job requires them to stand on hard surfaces all day. Elderly patients can also develop atrophy or thinning of the fat-pad which, therefore, does not cushion the heel and can be a cause of heel pain.
Heel pain usually occurs in the morning when first getting out-of-bed or after getting up after being seated for a prolonged period of time. Approximately 70% of patients will improve during an eight-week treatment program consisting of stretching of the Achilles tendon and plantar fascia. Nonetheless, it is not usual for heel pain to last a minimum of ten months. Additional treatment modalities include anti-inflammatory medication, a plastic heel-cup, arch supports, and a cortisone injection. Cortisone injections should be used sparely, and the rule of thumb is a maximum of three cortisone injections in one year. Surgery can be done as a last resort; however, operative intervention is not always successful for the treatment of chronic heel pain.
Southern Orthopaedic Specialists
Team Doctor for the New Orleans Saints National Football League Team
http://www.southern-ortho.com
Main Office: 2731 Napoleon Avenue, New Orleans, Louisiana 70115-6953
Telephone Number: (504) 897-6351
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