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Heel Pain

Plantar Fasciitis

There is a ligament along the bottom of the foot called the plantar fascia that stretches from the heel to the base of the toes. If the ligament is forced to stretch beyond its limit, it may become inflamed and result in heel pain, a condition called plantar fasciitis. Patients often complain of discomfort in the heel, the arch of the foot or the back of the leg when walking. The pain is usually worst when getting up after sitting or lying down for an extended period of time.

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Plantar Fascia Tear

Plantar fascia rupture is characterized by an acute pain in the arch of the foot following a dynamic activity. It is a relatively uncommon injury. It is often associated with long standing flat feet deformity. Treatment is non-operative, with pain control, relative rest, gentle stretching and a gradual return to activities over a period of weeks to months.

The injury is usually quite painful and therefore initial treatment is generally oriented towards pain control with ice, crutches and limited activity. As the symptoms begin to settle, often 4-10 days after the original injury, it may be possible to do more weight bearing, provided that stiff soled comfort shoes or a protective walker boot is used. At this point, gentle plantar stretching can be done.  Non-steroidal anti-inflammatory medication (NSAIDs) or pain medication can help with the symptoms. Return to reasonably normal standing or walking can occur relatively quickly in a few weeks. However, return to high level sports requiring sudden change of direction or explosive power through the plantar fascia region can be quite prolonged, in the order months.

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is a condition classified by chronic pain in the ankle, foot and toes caused by abnormal pressure on nerve roots. It is similar to carpal tunnel syndrome in the wrist and hand, but is not as common. The specific cause of tarsal tunnel syndrome is not known, but it can be a result of inflamed tissues around the tibial nerve, injury or other conditions that may affect the area.

The main symptom of tarsal tunnel syndrome is tingling or burning pain while standing or walking that starts in the ankle and spreads to the toes. Pain is usually relieved during rest. Doctors diagnose this condition by trying to induce the tingling sensation when tapping the nerve.

Treatment for tarsal tunnel syndrome depends on the cause of the pain but can include anti-inflammatory medication, orthotics, corticosteroid injections or surgery. Surgery is usually used as a last resort to relieve pressure on the nerve.

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