Why is the bottom of my heel painful?

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What is plantar fasciitis?

The plantar fascia, also known as the plantar aponeurosis, is the tissue that stretches across the bottom of the foot and connects the heel bone to the toes. Plantar fasciitis occurs because of inflammation of the plantar fascia, causing the base of the heel to become painful.

People who are at greater risk of developing plantar fasciitis include:

  • Individuals who engage in weight-bearing endurance activities (running or dancing)
  • Overweight or obese individuals (high BMI)
  • Individuals who wear shoes with inadequate support
  • Individuals who have flat feet or a high arch

The symptoms of plantar fasciitis include:

  • Stabbing pain in the bottom of the foot (usually the most painful immediately after waking up)
  • Pain after standing for a prolonged period of time
  • Pain when standing after sitting
  • Swelling on the bottom of the heel

This pain is normally exacerbated after exercise.

What causes plantar fasciitis?

While the cause of plantar fasciitis commonly remains unclear, in some cases, repeated tension on the plantar fascia might cause small tears. In addition, the plantar fascia might become inflamed after repeated stretching and tearing. These are all possible causes of plantar fasciitis.

What are the implications of plantar fasciitis?

While the pain experienced may be bearable at first, not seeking appropriate medical treatment can result in chronic heel pain that might affect your daily activities. Furthermore, some patients tend to adjust the way they walk to relieve the pain felt on the bottom of their heel, but this may instead lead to other foot or back problems in the future. Therefore, if you suspect you or someone you know might have plantar fasciitis, it is important to seek medical attention.

How is plantar fasciitis diagnosed?

Plantar fasciitis is typically diagnosed after comprehensive history taking, physical examination of the foot, and diagnostic imaging, such as X-rays.

In some cases, through x-rays, your doctor may discover the presence of a heel spur, which is bone formation at the insertion of the plantar fascia. It is a sign of underlying problems, but in itself usually does not cause pain. 

Plantar fasciitis can be treated by both non-surgical and surgical methods, which can be briefly summarised below:

Non-surgical treatment methods

  • Lifestyle changes
    • Avoiding going barefoot can help to reduce strain and stress on the plantar fascia, helping to relieve inflammation and pain.
    • Limiting physical activity can help your heel rest and recover
    • Making modifications to your shoes, such as purchasing shoes with good arch support and a slightly raised heel can help to reduce strain on the plantar fascia
  • Physical therapy
    • Physiotherapy and appropriate stretching exercises could help to relieve pain experienced on the plantar fascia.
  • Medications
    • Nonsteroidal anti-inflammatory drugs may be prescribed by your doctor in order to reduce inflammation and pain. However, do remember to communicate any drug allergies to your doctor.
  • Night splints
    • Dorsiflexion night splints may also be used for patients with plantar fasciitis. These patients wear the night splint while sleeping, helping them to maintain an extended stretch of the plantar fascia and therefore helping to reduce the pain experienced in the morning.
  • Other orthotic devices
    • Sometimes, using custom orthotic devices such as insoles or pads that are inserted into the shoe can help to support the foot and reduce the strain on the fascia.

Surgical treatment methods

Surgery is only used as a last resort to treat plantar fasciitis, when the pain is severe even with non-surgical treatment and lasts for more than six to twelve months.

  •  Gastrocnemius recession
    • Through this procedure, your doctor will lengthen the muscle and tendons at the back of your leg. More specifically, the surgeon will make a small incision on the inner side of the leg over the calf muscle before inserting a retractor between the gastrocnemius and soleus muscles. This will then allow the surgeon to access the fascia, causing the muscle to relax and length and causing the foot to be able to flex properly.
  • Plantar fascia release
    • During this procedure, your doctor will partially detach the plantar fascia from the heel bone, helping to reduce tension in the plantar fascia. In addition, your doctor may remove the smooth bone surface to help the plantar fascia heal, and may remove any heel spurs or damaged tissue. In some cases, your surgeon may also perform distal tarsal tunnel decompression during this surgery.
    • However, this procedure may also weaken the arch of the foot, and in some cases, the range of mobility of the foot may be reduced after the surgery.

After surgery, patients may be required to wear orthopaedic devices to support the foot, such as a boot for at least two to three weeks after surgery. This will aid the patient in avoiding putting weight on the foot and allowing the tissues to heal. Furthermore, your doctor will also recommend physiotherapy in the form of strengthening and flexibility exercises.

For assessment of your condition, please book an appointment with Dr. Yong Ren.

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Sarah Taylor

Obstetrics & Gynaecology