The main causes of heel pain are due to repetitive trauma to bare feet and plantar fascitis. The heel bone (calcaneous) is the largest bone in the foot and bears 50% of the weight. It is also part of the mechanism our feet use for walking and running. As we step down with each stride, the heel moves in different positions. This is how we adapt to uneven surfaces or create a rigid level for running. Our foot also moves in a certain fashion to absorb shock.
A part of this complex is a ligament referred as the plantar fascia. The best way to explain this complex is to consider a triangle. The base represents the plantar fascia, the heel bone is one of the sides, with the front foot as the other side. As our foot flattens, the top or apex of the triangle moves in a downward direction. This requires the base to lengthen. The base (i.e. plantar fascia) must stretch to achieve this. This stretching, especially at abnormal amounts, inflames and even tears the plantar fascia. This results in pain. The textbook symptoms of plantar fascitis include pain with first steps. Usually patients describe waking up in the morning with sharp or aching pain for approximately 15 minutes. The pain decreases, but returns at the end of the day. In a lot of cases, the pain is all day. The pain is described as stepping on a nail. Heel pain in children is usually due to inflammation of the growth plate in the heel. The age range for this disorder is 9 to 15 years old. Sports and aggressive activities magnify this condition.
Treatment consists of anti-inflammatory medication, cortisone injections, orthotics, night splints, physical therapy, and release of the plantar fascia. There are 2 techniques for releasing the plantar fascia. The first is the traditional method of an open release. The second uses a small tube for an arthroscope. The visualization and release takes place through this tube.
