Joseph Yao

Heel pain

Heel pain can occur in various locations, but the focus of this article will be pain in the bottom (plantar) aspect of the heel. The most common reason for pain in the plantar heel is plantar fasciitis.
     The plantar fascia (PF) is a support structure for the arch. It rises from the bottom of the heel bone (calcaneus) and extends along the bottom of the foot toward the bases of the toes. The arch can be viewed as a bow and the PF as the bowstring. The PF stretches slightly with each weight-bearing step as the arch flattens. Plantar fasciitis usually involves an inflammation to the area where the PF attaches to the calcaneus. 95 percent of plantar fasciitis cases will resolve within six months.                     Plantar fasciitis pain is usually located just medial (toward the great toe side of the foot) and distal (in the direction of the toes) to the center of the plantar heel. Pain may radiate into the arch area. Pain is usually worst upon initiating walking after a period of non-weight bearing such as occurs when getting out of bed or walking after sitting for a while.               
There are many causes of plantar fasciitis including “bruising” the heel from jumping down from a truck’s cab, pressure from an ill-fitting pair of shoes, weight gain and inactivity resulting in calf muscle and PF tightness. Truck drivers can be prone to developing plantar fasciitis because of long hours of sitting and bruising the heel when getting down from a truck cab or trailer.
     Ninety-five percent of plantar fasciitis can be effectively treated conservatively. Oral nonsteroidal anti-inflammatory medications are generally ineffective. Exercises for calf muscle and PF stretching are important and can be accomplished by doing a runner’s-type stretch. A person can grab hold of a door jam or other object and place the painful foot flat on the floor behind them. Stretch by leaning forward first with the knee straight and then with the knee bent.
      Other treatment includes heel pads (to cushion the PF attachment site), arch supports (to minimize flattening of the arch with weight bearing and thereby reduce tension at the PF attachment site), local steroid injections into the PF attachment site and the use of a short leg-walking cast. Extracorporeal shock wave therapy uses forceful sound waves directed at the PF attachment at the heel.
     Five percent of plantar fasciitis cases fail to resolve with conservative treatment and may be due to a tear or degeneration of the PF attachment to the calcaneus. These cases can be treated with surgery to cut the PF attachment to the calcaneus, done through a small incision in the medial heel, but it can also be done using an arthroscope.
     Dr. Joseph Yao has undertaken extensive subspecialty training in joint re- placement after completing an orthopedic surgery residency. He has been in private practice orthopedic surgery since 1987, and he has treated many truck drivers for joint and nerve ailments.