How to Tell if Heel Pain is Plantar Fasciitis
Foot pain can have many causes, including arthritis and plantar fasciitis. A correct diagnosis is key to the right treatment.
Pinpointing the cause of heel pain can be deceiving, especially if arthritis affects another part of your body. Osteoarthritis (OA), rheumatoid arthritis (RA), gout and other forms of arthritis and related conditions like tarsal tunnel syndrome — a pinched nerve — can all impact the foot. But one of the most common forms of foot pain, especially in the heel, is plantar fasciitis.
“These conditions have very different treatments. A correct diagnosis is critical,” says orthopaedic surgeon Steven Haddad, MD, president-elect of the American Orthopaedic Foot and Ankle Society and a spokesperson for the American Academy of Orthopaedic Surgeons. The earlier you see a doctor, the better your chances of effective treatment.
Plantar fasciitis affects more than 3 million people a year. Sharp pain, inflammation and/or tenderness of the sole of the foot near the heel are hallmark symptoms of plantar fasciitis. Pain, usually with the first few steps in the morning or after sitting for a while, improves as you walk around, but worsens later in the day — unlike osteoarthritis, which can last all day and worsens when moving or walking around.
The plantar fascia, a ligament connecting the heel to the ball of the foot, loses elasticity and develops tiny tears. The tears cause painful swelling in the ligament. Medical history, physical exam including range-of-motion tests, and an X-ray are all used to diagnosis plantar fasciitis, which can last several days or weeks, even months if not treated promptly and properly.
Ninety-five percent of individuals who develop plantar fasciitis find relief through non-invasive, non-surgical treatments.
Ice therapy and stretching are good starts, but make sure you stretch daily. Avoid shoes with flimsy soles, and if your favorite pair of shoes doesn’t have arch support, purchase a firm over-the-counter arch support insert – or get fitted for a custom-made device by a podiatrist or orthopedist, says Craig Gastwirth, a podiatrist at Foot Healthcare Associates in Southfield, Michigan. Shoes with a slight heel — even half an inch to an inch — take the pressure off the plantar fascia, which is why some women with this condition claim to feel better in heels than they do in sneakers.
Gastwirth strongly urges patients to see a podiatrist or orthopedist to be fitted for a plantar fasciitis splint. Worn at night, this device passively stretches the bottom of the foot and the back of the heel while you sleep. “In my experience, it can be extremely helpful in reducing and even eliminating pain,” says Gastwirth.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may also help, as well as steroid injections. Sometimes it’s necessary to get more than one steroid injection, but Gatswirths recommends avoiding more than three injections over the course of three to six months. “Any more and you can actually exacerbate the condition,” he says.
If more conservative options fail, you may be a candidate for surgery to release the plantar fascia. Typically, surgery is only considered for people who’ve had symptoms for at least nine months and who continue to have pain despite daily treatment.
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