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Heel Pain or Plantar Fasciitis?

Heel Pain or Plantar Fasciitis?

Summer is here! You've busted out the sandals, brought out the boat shoes, and you're flaunting those flats but don’t forget the burden these beauties are carrying: your feet.  More specifically, your heels. The flimsy, flexible footwear coupled with increased activity (among other factors which we will discuss), have many patients rushing in to have their heel pain evaluated. So, let’s tackle the most common cause of heel pain: plantar fasciitis – a condition coined as “heel spur syndrome” many years ago. As you might imagine, there are many other reasons for heel pain. Tendinitis, a stress fracture, nerve irritation, or a cyst are all causes of heel pain, just a to name a few. I mention these simply to point out that it’s important to have a professional evaluate your heel pain before you initiate any self-treatment.

So, plantar fasciitis. We’ve all heard of it, but what is the plantar fascia? Some people mistakenly refer to it as the “plantar fascia ligament”? Well, it’s not actually a ligament, but for the sake of our discussions, let’s think of it that way. That ligament-like band of connective tissue starts at the base of the heel bone and fans out into three major branches that span the bottom of your foot and they all insert at the joints at the ball of your foot. When the fascia becomes inflamed, the result is heel pain. So the “itis” in plantar fasciitis simply means, “inflammation of" the plantar fascia. Patients often say the pain as worst when they get up in the morning or after they have been sitting for long periods of time. The pain usually improves after walking and stretching the fascia. Of course, not everyone’s body reads the anatomy textbook and the pain for some people may get worse after spending progressively longer periods of time on their feet.

The exact cause of plantar fasciitis is a bit of a complex answer but it can be boiled down to simply faulty architecture of the foot that results in abnormal mechanics due to forces external to the foot. People who have either overly flat feet or high arches, are more inclined to developing plantar fasciitis. But there are a lot of different factors that combine to increase the risk of developing heel pain. For instance, take those flimsy, flat, unsupportive shoes, mix them with the hard surfaces of NYC streets, and add a dash of increased activity, a job that requires long periods of standing, and/or someone who is carrying an extra few pounds, and Voila! You have yourself a perfect recipe for plantar fasciitis.

How do we diagnose plantar fasciitis? Because of all of those “other things mentioned above”, it’s important that your heel pain be evaluated by a professional. Here at Chelsea Foot and Ankle we always start with obtaining a thorough medical history, getting a sense of your daily activities, and examining your foot. If we think your pain is coming from one of those “other things mentioned”, we may use diagnostic imaging studies, such as x-rays, ultrasound, or other imaging modalities to confirm the diagnosis.

Treatment of plantar fasciitis is tailored to each patient. What works for you might not work for the person sitting next to you. However, it usually begins, for everyone, with some simple things you can do right at home: Stretching exercises, icing the bottom of your foot, refraining from those high impact activities, avoiding going barefoot, shoe modification (ditch those flimsy flats), and oral medications such as NSAIDs. If after several weeks you still haven’t made a comeback, we will likely add some other treatment modalities such as injection therapy, orthotics, a night splint, or physical therapy. The important thing to remember is that, regardless of the kind of treatment you undergo, that faulty architecture of your foot remains. It’s crucial you continue to stretch, wear supportive shoes, and follow up with your doctor at Chelsea Foot and Ankle on a regular basis.



If I were to create a list of the top 3 complaints I hear from patients when they come to the office it would be: bunions, hammertoes, and heel pain. We’ve already tackled bunions so let’s explore hammertoes.

Some common questions you might have when pondering your hammertoes: what is a hammertoe? What causes it? Can I blame grandma?  What can I do to be pain free?

A hammertoe is a deformity of the second, third, fourth, and/or fifth toes. The middle joint of the toe (also called the proximal interphalangeal joint) begins to bend downward. The resulting deformity starts to loosely resemble a hammer. There are a few variations of hammertoes depending on where the bend is located. For example, a mallet toe is a bend in the joint closest to the toenail (the distal interphalangeal joint). A bend in both the middle and end joints is called a claw toe. Regardless of the type of hammertoe, the causes (and treatments) are very similar.

So, can you blame your mom, dad, or grandparents for the hammertoe that is preventing you from getting into those nice pair of shoes? Unfortunately, it may the nice pair of shoes that caused the hammertoe. Hammertoes are a result of muscle imbalance brought on by ill-fitting shoes along with a couple other factors. Narrow shoes and high heels change or restrict the pull of the muscles that help straighten and bend the toe the correct amount. Over time the muscles shorten causing a contracture of the toe. Left untreated, corns and calluses may develop on the top of the toes or bottom of the feet. After a prolonged period of neglect, the toe may become rigid and fixed in the hammered position, requiring surgery.

What can you do for these pesky painful piggies? Treatments for the condition typically involve wearing shoes with a wider toe box, doing toe exercises, physical therapy, and using toe strappings or cushions. It’s important to understand that these conservative methods cannot reverse or straighten the hammertoe once it’s started to form but it often can slow down or arrest it from worsening. If you’ve tried all of the above and it’s still bothering you, then you should consider discussing surgical options with your doctor.

Up next: heel pain. Stay tuned.


Interested in having your hammertoe evaluated? Feel free to email or call our office for a consultation.