Plantar Fascitis (Heel Pain)

Heel pain is an extremely common, everyday complaint seen in all age groups, and despite how bothersome it may be, serious pathology is rarely encountered.

In the child and adolescent, it usually represents a response to the everyday stress that occurs in the growth area of the calcaneus, which is the anatomic name for the heel. This condition usually responds to some sort of protective device which elevates the heel and cushions the heel during impact activities.

This symptom in the child will disappear with completion of growth, and it is important to note the activity need not be restricted.

In the adult, the symptoms commonly evaluated is that of pain in the middle of the heel or the bottom of the foot beneath the heel. One most often complains of pain when they first arise in the morning or pain after sitting and then arising to walk. The pain may worsen with standing or with prolonged walking.

Patients are often told that they have a “heel spur”. The medical term for this painful syndrome is plantar fasciitis, which describes a benign and often chronic inflammatory condition.

The majority of the population of adults will be noted to have a visible “spur” as age increases. A spur will develop anywhere on the body where a ligament attaches, and becomes visible on an x-ray. Removal of a spur is not necessary to solve the problem.

The source of the pathology in the adult is an inflammation in the area where the plantar fascia connects to the heel. The plantar fascia is a broad ligament which stretches along the bottom of the foot. This condition will ultimately respond to a variety of treatment methods. It is important to note that without treatment the condition may well disappear on its own. It usually responds to the use of one of many devices which may be worn in the shoe. In the adult who is not responding to shoe inserts, we may resort to injections of cortisone.

Although there is an operation described for treatment of plantar fasciitis, the majority of orthopedic surgeons feel that surgery is necessary only on rare occasions.

If one were never treated, the situation would not progress to a more serious problem. It does not become an arthritic problem, and is never a disabling problem.

Finally, activities need not be restricted for any long period of time. For instance, continuing to walk for exercise does not worsen the condition and does not cause harm.

Plantar fasciitis is probably the most common nonsurgical foot complaint that an orthopedic surgeon sees on a regular basis.