Plantar Fasciitis is without a doubt the most common cause of heel pain - 10% of people are afflicted with it at some point in their lives. But if your heel pain continues for more than 2 months, it may not be plantar fasciitis at all.
Heel pain that lasts more than 8 weeks may be caused by a ligament tear in the heel, whose initial symptoms are almost identical to plantar fasciitis. However, the treatments for the two conditions are very different. In the case of a misdiagnosis, the treatment for plantar fasciitis can even make your heel pain worse.
Plantar Fasciitis or Plantar Fascia ligament tear?
Plantar fasciitis is a micro tear of the plantar fascia ligament, which occurs from overuse (too much demand on the ligament). A plantar fascia rupture (or tear) is less common and typically more painful. Pain from either injury will be felt in the bottom of the heel.
Even though the two injuries affect the same ligament, the treatment for plantar fasciitis vs. a plantar fascia tear are practically polar opposite. If you have a typical case of plantar fasciitis, the treatment protocol is usually stretching exercises via physical therapy, rest, ice, over the counter anti-inflammatories (ibuprofen or naproxen), and in some cases custom orthotics. If a patient follows the prescribed treatment, their plantar fasciitis will usually heal in 3-6 weeks.
But if your heel pain is caused by a tear to the plantar fascia ligament, those stretching exercises may make your condition worse. Healing a plantar fascia tear takes anywhere from 2-5 months, depending upon its severity. Treatment typically involves immobilization of the foot and lots of rest, to allow the tissue time to reconstruct without further stress. In some cases, surgery will be necessary to completely repair the ligament.
For this reason, a visit to a podiatrist is always recommended for heel pain. The subtle differences in these injuries can easily be missed by a general physician, and the wrong treatment can worsen your condition. Heel pain also puts more stress on the other joints in your body, as we shift weight off of our heel. It's common to develop pain in the ankle, knees and back as well when we have heel pain.
The best way to prevent heel pain is to be proactive. Wear supportive shoes to work and properly fitting and padded athletic shoes when you exercise. The key to protection is arch support and padding in the heel to absorb impact. It's also a good idea to do a proper warm-up before exercising, including gentle stretching exercises for your legs, ankles and feet.
Every parent knows that their children's feet grow at alarming speed. One day you buy them new shoes and the next day the shoes are too tight. It's enough to make you want to send them into the world barefoot.
The never-ending growth spurts in children's feet are due to the fact that the foot is one of the first parts of the body to grow to full size. This speedy growth is accompanied by uneven development in the lower leg and ankle, making muscles and tendons very tight and the heel less flexible. This inflexibility exposes the heel to injury and places a lot of stress on the growth plate, a soft area at the end of the heel which eventually fuses with the heel bone (calcaneus).
Sever's Disease (calcaneal apophysitis), the most common cause of heel pain in children, is a painful inflammation of the heel's growth plate. The heel bone is not fully developed until age 14 or 15, and is constantly adding new bone at the growth plate (physis). When the growth plate is subjected to a lot of repetitive stress, like that in athletics, inflammation can develop.
It should be noted that the symptoms of heel pain in adults are different from heel pain in children. In adults, heel pain is usually at its worst in the morning and decreases or subsides as the tissue warms up with activity. But in children, heel pain usually doesn’t diminish as the child moves around – in fact it may get much worse.
Fortunately, Sever’s Disease is a temporary condition and with rest and treatment, symptoms will usually subside within 8 weeks. If the condition persists, it's important that your child sees a podiatrist for a thorough evaluation and treatment plan. The risk of recurrence of Sever’s Disease diminishes with age and typically doesn't occur after 15, when foot growth is complete and the growth plate has fused to the rest of the heel bone.
Factors which contribute to Sever's Disease
- High level of physical activity
- Long periods of standing which put pressure on the heel
- Flat feet or a high arch
- Pronated foot - one which rolls inward when walking
- Short leg syndrome (one leg is shorter than the other)
Symptoms of Sever's Disease
- Pain or tenderness at the back of the heel, and/or along the side and bottom of the heel, extending to the arch
- Redness and swelling in the heel
- Difficulty walking or running
- Feet are stiff upon waking
- Heel pain increases with activity
- Child walks on tiptoes, limps, or favors one foot over another
To relieve your child's heel pain
- Ice and elevate the foot
- If approved by physician, use over the counter pain medicine to control pain
- Suspend athletic activities until pain subsides
- Wear athletic shoes which fit properly and pad the foot
- Of obese, begin weight management program
- Stretching exercises for the heel and hamstrings (under supervision of physical therapist)
- No high heeled shoes
If your child complains about heel pain, don’t take it lightly, as early intervention and treatment by a podiatrist is key to a continued healthy development.