According to Dr. Marc Blatstein, morning heel pain’s most common complaint is that of pain upon standing first thing in the morning. While the pain initially is excruciating, with ambulating the pain may subside only to come back again with a vengeance after sitting and then standing up again.
The plantar fascia, is a ligament attached at one end to the bottom of the heel, then fanning out into the ball of the foot, attaching onto the toes, thus acting like a shock absorber for the foot. As the foot impacts the ground, with each step the plantar fascia stretches slightly. When these excessive pressures of pulling the plantar fascia on the heel occur over time, or with an innocent step (like stepping on a marble or off a curb), they create small tears in the plantar fascia (the ligament on the bottom of the foot) resulting in a small amount of bleeding, pain & inflammation. Medical literature originally thought that heel pain was due to a bone spur on the bottom of the heel bone (or calcaneus). We now know that the pain is due to excessive tension on the plantar fascia as it tears from its attachment into the heel bone.
In the diagnosis of heel pain, Dr. Marc Blatstein relates that over the years, patient care has demonstrated that not all bone spurs are painful, and everyone with heel pain (or plantar fasciitis) does not necessarily have to have bone spurs. A complete history and physical exam plays a large role in approaching this diagnosis, along with weight bearing x-rays, are useful in determining if a heel spur is present, or if other pathologies are contributing to the diagnosis.
Initially, treatment by Dr. Marc Blatstein can start with a combination of one or all of the following: padding & taping of the foot in a supportive nature, taking oral anti-inflammatory medications, immobilization of the foot in a walking cast, physical therapy as well as implementing specific stretching exercises. Should additional treatment be necessary, cortisone injections as well as orthopedic functional foot orthotics may be prescribed. Should any or all of these treatments fail, and after a detailed review of X- Rays, Lab results with your physician; surgical intervention may be considered, and according to Dr. Marc Blatstein is very effective. Here an Endoscopic Plantar Fasciotomy is one (of many) of the possible procedures that could be recommended. A plan then is formed between you and your doctor for a successful outcome that is meant to add a full and enjoyable life to your years.