Plantar Fasciitis, Heel Spurs, and Treatment Options

Under normal circumstances, your plantar fascia acts like a shock - absorbing bowstring, supporting the arch in your foot. But if the tension on the bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed, and leads to adhesions in the fascia and surrounding tissues.

There are many potential causes when dealing with foot pain, heel spurs, and plantar fasciitis.

One possible cause is mechanical misalignment of the foot. This places excessive tension on the fibrous plantar fascia, causing pain and inflammation, which is called plantar fasciitis.

A second cause can be from degeneration of the fat pad under your heel, which is primarily caused by poor footwear. Shoes without a proper heel cup, or worse yet, without any heel cup (flip-flops), can flatten that fat pad quite quickly.

Wearing footwear such as high-heeled shoes, including western-style boots, for long periods of time can cause the tough tendon-like tissue of the bottom of the foot to become shortened.

Why do I have a heel spur and what is causing it?

A heel spur is a bony overgrowth on the bottom or your heel bone. The heel spur is usually a result of an inflamed tendon that attaches the plantar fascia, across the arch of your foot and inserts on the heel (calcaneous). When the tendon becomes irritated your body attempts to support the area and starts to deposit bone, as a protective measure. The size or presence of a heel spur does not always correlate with the amount of pain you have.

Heel spurs can be created from a multitude of causes: being overweight, having poorly fitting shoes or high heels, biomechanical foot and gait problems (a complex motion including forefoot, heel, ankle, knee, and hip motions), gout, and rheumatoid arthritis.

What symptoms are associated with heel spurs and plantar fasciitis?

Heel pain is usually worse in the morning, especially with the first few steps, or after periods of rest. Some relief can be found following activity, but pain returns after extended amounts of time standing or walking. As the condition intensifies, there can be pain felt even while resting. The pain occurs because you are stretching the adhered plantar fascia. Heel and sole pain are the classic symptoms but ankle pain may also be present. The pain is usually sharp and is located primarily where your heel and arch meet, but can be located anywhere on the arch.

There is a possibility in some cases that the pain will go away on its own. However, in most cases, the longer you wait to seek treatment, the more chronic the condition becomes, making it more difficult to achieve your desired results.

Treatment Options for plantar fasciitis and arch pain

There are many conservative treatment options available. To begin with, simple shoe modifications such as well designed foot insole, padding, and support can help alleviate the tension on the plantar fascia. Foot orthotic inserts can provide support for stressed joints and soft tissues. They are often constructed to increase shock absorption. Custom orthotics have helped many patients in our office improve their quality of life.

Another effective appliance would be a plantar fasciitis night splint. This basically is a sock that can be worn at night that keeps the fascia in a stretched state to promote plantar fascia lengthening.

Ice massage is another commonly used treatment option. Take a paper cup and place it in the freezer with water in it. Once it is frozen peel the paper down exposing some of the ice and have someone massage the arch of your foot with the block of ice until the area becomes numb.

If padding and splinting seem to be ineffective the next course of treatment which I use with my patients do is to start breaking up the fascial adhesions in the foot. The best way to do this at home is to place a golf ball on the floor and place your foot on top of it. With moderate pressure, to your tolerance, roll the ball around on the arch of your foot. If this proves to be too intense, a soup can or tennis ball can be substituted instead.

If pain and discomfort persist after these ultra conservative measures have been exhausted, a more aggressive approach should be tried under the instruction of your health care professional. In our office we offer you creative solutions in breaking up the adhesions, either by hand or with the assistance of specially designed tools.

Mobilizing the bones of the foot and ankle has been a very compelling treatment option in our office. This mobilization is normally performed by a small thrust by hand (adjustment) or activator to correct faulty movement patterns that have developed over time.

Physical therapy is the next step in our dynamic approach. We utilize ultrasound and cold (soft) laser to facilitate faster recovery and promote tissue healing. We also teach you a specific stretching regimen to help reestablish more functional movement patterns.

For more information about other foot treatment alternatives check out our ankle injuries page.

This article is not written for the purposes of diagnosing, treating, or rehabilitating any condition, symptom, or disease. This is written for informational purposes only. Please have your condition evaluated by a healthcare professional.