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Heel Pain

Heel Pain. Richard I. Lebovic, DPM Linden – (908) 925-1500 East Brunswick – (732) 613-1166 www.AccentonFeet.org. Plantar Fasciitis. Inflammation and pain along the plantar fascia - the tissue band that supports the arch on the bottom of the foot

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Heel Pain

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  1. Heel Pain Richard I. Lebovic, DPM Linden – (908) 925-1500 East Brunswick – (732) 613-1166 www.AccentonFeet.org

  2. 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 • Becomes chronic in 5-10% of all patients • Is not necessarily associated with a heel spur • Over 90% resolve with conservative treatment

  3. Plantar Fasciitis Symptoms • Pain on standing, especially after periods of inactivity or sleep • Pain subsides, returns with activity • Pain related to footwear – can be worse in flat shoes with no support • Radiating pain to the arch and/or toes • 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

  4. Plantar Fasciitis Risk Factors • Biomechanical abnormalities • Overly tight calf muscle • Poor shoe choices • Weight gain • Barefoot walking • Work surface

  5. 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

  6. Plantar Fasciitis Evaluation & Diagnosis • Pain with pressure on bottom of heel or arch • Limping • Foot Type: low vs. high arch, pronation • X-ray findings – Spur? Other abnormalities? • Ultrasound • Nerve Conduction Velocity studies to evaluate potential nerve problems • MRI –rarely used. Mostly for chronic, unresponsive cases

  7. Plantar Fasciitis Treatment • Mechanical – treat the cause • Anti-inflammatory – treat the pain • Neither done in isolation

  8. Plantar Fasciitis Treatment • Stretching, shoe modifications, avoid walking barefoot • Icing and rest • Night or resting splint • Supplemental arch support (OTC vs. custom orthotics) • Anti-inflammatory medication • Steroid injections • Physical therapy • If conservative measures fail, surgery is an option

  9. Other options for heel pain • Over 90% of heel pain patients respond to initial therapies within a relatively short period of time • For unresponsive cases, options include: • Minimally invasive procedures like ESWT (Extracorporeal Shock Wave Therapy) • Autologous Platelet Concentrate (APC) injection • Surgical procedures, open or endoscopic • Cryosurgery • Radiofrequency techniques

  10. Visit Your Podiatrist • For more information on heel pain, or for a diagnosis, contact your podiatrist: • Richard I. Lebovic, DPM • Linden – (908) 925-1500 • East Brunswick – (732) 613-1166 • www.AccentonFeet.org Thank you for coming today!

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