Ronald W. Smith, M.D.

Golfer’s Heel

heel_painI.      Definition:  Heel pain, also known as plantar fasciitis, is often compared to tennis elbow.  They are both conditions that develop gradually, characterized by pain and inflammation of tendon-like structures. Heel pain is located underneath the heel where muscles in the arch of the foot attach to the bottom of the heel bone.  The pain usually flares up with the first few steps after inactivity, such as with the initial steps in the morning.  It is the most common foot and ankle problem for the middle aged and senior populations, however it is also common among people in their 30s and 40s.

II.      Cause:   A number of factors are associated with the onset of plantar fasciitis.

•    Increase in the frequency and intensity of a walking/running program
•    Prolonged standing
•    Heavy labor
•    Walking on hard surfaces or floors
•    Repetitive trauma
•    About 50% of patients with heel pain also have a bone spur seen on x-rays.  However, the effect of this bone spur, and its precise association with heel pain is unclear.  Recent studies provide substantial evidence that this commonly discovered spur is not a cause of the pain.

III.      Treatment and Prevention:  Heel pain can be treated with a number of techniques, yielding excellent results.

•    Decreasing a stress-inducing activity, such as reducing a running/jogging program to every other day rather than every consecutive day, can reduce heel pain.
•    Wearing shock absorbing shoes in combination with cushions or orthotic devices can reduce the stress on the ligament.
•    Calf muscle stretches, stretching the arch, and plantar strapping (using a tape arch support) may be prescribed by your orthopaedic specialist.
•    Over the counter anti-inflammatories and cortisone injections can relieve the pain and inflammation.
•    A temporary cast may minimize the stress of walking and rest the plantar fascia.
•    Relatively new equipment allows treatment with shock waves as used for “crushing” kidney stones.
•    If non-operative treatment fails, surgery can release tension in the plantar fascia.  One technique uses only minute incisions and has a short recovery time.

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