From the Guidelines
Heel pain is most commonly caused by plantar fasciitis, which is inflammation of the thick band of tissue (plantar fascia) that connects your heel bone to your toes. The typical cause of heel pain can be attributed to repetitive stress creating small tears in the fascia, leading to inflammation and pain, particularly with the first steps in the morning or after periods of rest 1.
Key Factors Contributing to Heel Pain
- Repetitive stress on the heel
- Poor footwear
- Overuse or sudden increase in physical activity
- Anatomical issues such as flat feet or high arches
Treatment Options
- Rest, ice application, and over-the-counter pain relievers such as ibuprofen or naproxen are initial treatment options 1
- Stretching exercises, particularly calf and plantar fascia stretches, should be performed several times daily
- Supportive footwear with good arch support and cushioning is essential
- Custom or over-the-counter orthotic inserts may provide additional relief
- Night splints can help maintain a stretched position of the plantar fascia during sleep
Diagnostic Approach
- Radiography is usually the first imaging study in evaluating patients with chronic foot pain, including heel pain 1
- Ultrasound may be performed when there is a high clinical suspicion of pathologic conditions of the Achilles tendon, plantar fascia, and other conditions such as tarsal tunnel syndrome, Morton’s neuroma, plantar plate tears, and intermetatarsal bursitis 1
Management and Prognosis
- Most cases of heel pain due to plantar fasciitis resolve within 6-12 months with consistent conservative treatment 1
- If pain persists beyond several weeks of home treatment, physical therapy, steroid injections, or in rare cases, surgery might be necessary 1
From the Research
Typical Cause of Heel Pain
- The most frequent cause of heel pain is plantar fasciitis, a common complaint among patients in podiatric or orthopaedic office settings 2.
- Plantar fasciitis is a condition that affects the plantar fascia, a band of tissue that runs along the bottom of the foot and connects the heel bone to the toes.
Treatment of Heel Pain
- Treatment of plantar fasciitis ranges from conservative measures to surgical interventions, but most cases can be managed conservatively 2.
- Combining corticosteroid injection and physical training (strength training and stretching) has been shown to result in a superior effect compared to each treatment separately 3.
- Corticosteroid injections combined with controlled training are recommended as first-line treatment in patients with plantar fasciitis 3.
- Radial extracorporeal shockwave therapy (rESWT) and ultrasound-guided corticosteroid injection treatment are also effective modalities for treating chronic plantar fasciitis, with rESWT seeming to be superior due to its longer duration of action 4.
- The effectiveness of corticosteroid injection in treating plantar fasciitis has been demonstrated in several studies, with significant reductions in pain observed in patients treated with corticosteroid injections 5, 6.
Comparison of Treatment Options
- A systematic review and meta-analysis compared the role of corticosteroid injections with platelet-rich plasma (PRP) and extracorporeal shock wave therapy (EWST) for plantar fasciitis treatment, and found that PRP achieved better VAS scores compared to corticosteroid injections at 3 and 6-month follow-up 6.
- The same study found that EWST had better VAS score outcomes at 6 months compared to corticosteroid injections, and that PRP was more efficacious than corticosteroid injections at 6 months of follow-up 6.