Heel Pain
Heel pain of the feet can be called several different things. The common terms are heel spurs, plantar fasciitis, and heel spur syndrome. Basically, they all revolve around heel pain located on the bottom of the heel.
Patient will relate that the pain is sharp in nature and is located at the back of the heel along the medial calcaneal tuberosity. This located is towards the back of your heel right where your arch begins. You can usually elicit the symptoms of pain by placing you thumb on the area.
Also the discomfort can be generated during those first several steps when you first walk following sleeping or sitting. As time passes patient will relates a feeling of a "swollen heel", although the symptoms can be diverse in nature.
The diagnostic tools that can be used to develop a differential diagnosis very across the spectrum. First, The physical exam with a history and physical is step one. At that point a determination of further testing modalities can be selected. Xrays and imaging ultrasound should be considered.
Why xrays and imaging ultrasound?
Xrays take a look at the osseous( bony) structures of the foot. This will allow us to rule out bone tumors and the presents of a "heel spur". The majority of the population believe that if you have a heel spur you will have heel pain. The truth is, 20% of the populations have a heel spur but no pain.
Ultrasound:
Diagnosis ultrasound is an excellent way in which to look at the soft tissue structures on the plantar aspect of ones foot. A normal plantar fascia is uniform in shape and density. Pathological plantar fascia can be fusiform, meaning thin in one area but thick in another. Also the fascia will be heterogeneous in nature with hypo-echoic areas within the fascia.
Treatments:
The spectrum of treatments for heel pain vary from stretching exercises, over the counter inserts,change shoes, orthotics, strapping, injection therapy, physical therapy, night splints, NSAIDS, oral steroids, Endoscopic Plantar Fasciotomy, and heel spur resection,
From my experience the treatment of heel pain can be broken down into the "inflammatory stage" and "biomechanical stage".
The goal of treatments for the inflammatory stage is to lessen the inflammation. This in turn will decrease the patients symptoms. Injection therapy by-fare is the fastest and most efficient means of decreasing the pain. I only lean towards injection on the first visit if the patient can barely walk into the office.
If an injection is determine to be necessary we need to focus that the steroid to the specific spot. This can be determined by physical located the spot or under ultrasound guidance.