Heel spurs and plantar fasciitis are the most common causes of heel pain.
Plantar fasciitis is the inflammation of the ligament-like structure called the plantar fascia in the form of a thin long band located just under the skin on the sole of the foot.
A heel spur is a bony protrusion that occurs at the base of the heel bone. It is a bony prominence formed when the band-shaped stretched plantar fascia stretches under excessive load and pulls the bone. This bony prominence is detected on the x-ray in half of the patients with pain, that is, it can be observed in patients without heel pain. The cause of the pain is not this bone spur. Therefore, this protrusion can be treated without the need to remove it.
The most important task of this tape structure is to reduce the excessive stress and tension on the sole of the foot while standing. Even if it is exposed to more load than it can carry, heel spur disease occurs.
The risk factors that cause overload are as follows; standing for long periods of time due to obesity, work or sports. Overloading and standing too much is causing the heel to be overloaded with more than it should be. For this reason, it is a common situation among housewives.
Heel spurs are also common in rheumatic diseases. Especially if there are complaints in both heels, research should be done in terms of rheumatic disease.
Patients complain of increasing pain over time on the sole of the foot, under the heel, without significant trauma. The pain is distinctly and clearly described at the sole on the inside of the heel.
There is a complaint of pain under the heel that increases over time. Patients tell that they feel the most severe pain with the first step when they wake up in the morning or after sitting for a long time in the car seat or the first step when they get up from the chair.
There may even be limping due to pain. In order not to burden the painful inner part of the heel, the patient develops a new walking style by pressing on the outer part of the foot; This wrong way of walking causes pain in the outer comb bones of the foot, muscles in the legs, knees and waist, and back.
Heel spurs and plantar fasciitis can be easily recognized by carefully listening and questioning the patient, and by physical examination in which the exact location of the tenderness in the heel is determined.
X-ray and MRI are actually used to rule out other diagnoses when needed or when treatment fails.
The thickening of the band structure and the tears inside are detected with USG, and the response to the treatment is followed.
A high rate of success is achieved with supportive treatment (painkillers, rest, ice application, anti-inflammatory drugs, exercise, supportive shoes and insoles, night splint, physical therapy).
ESWT, shock wave therapy can be preferred in patients with long-term complaints.
There is also the option of PRP injection to the heel for long-term complaints.
Surgical treatment is considered in patients who do not respond to supportive treatment.