A 32 Year Old Man Complains of Heel Pain

A 32 year old man visits his primary care physician with the complain of pain in the heel of his foot for the last few weeks. He describes the pain has stabbing in character and usually occurs when he wakes up and takes the first steps in the morning. the pain then gradually decreases as the day goes on. Patient says he is an active man and he has been training himself in the local gym for the last few months. On examination there was tenderness on palpation of the heel and the sole of the foot. An X ray of the foot is shown below:

The arrow shows a heel spur.

The patient is most likely suffering from plantar fasciitis.

Case Discussion:

PLANTAR FASCIITIS

Inflammation of plantar fascia on the planter aspect of foot.

Risk factor for developing plantar fasciitis:

-                     flat feet or high arch

-                     running long distances, up or downhill or on uneven surfaces

-                    Obesity

-                    Wearing shoes with poor arch support or soft soles

Clinical features: 

• -          Heel pain, usually unilateral, which is most severe during the first few steps after prolonged inactivity such as sleep or sitting
• -          Symptoms are typically relieved by giving rest to the affected foot (via sitting, elevation or other means)
• -          Pain may be worsened by walking barefoot on hard surfaces or by climbing stairs
• -          Patients who are generally on their feet all day report that symptoms are the end of the day

Signs:

-          Palpation of the medial plantar calcaneal region will elicit a sharp stabbing pain.

Management:

Non-pharmacological:

• -          Ice packs over the affected heel
• -          Proper foot wear e.g. shoes with arch support, soft heels and heel padding
• -          Achilles tendon stretching exercises
• -          Weight loss in obese patients

Pharmacological

• -          NSAIDs e.g. tablet Ibuprofen/ Diclofenac sodium/ Naproxen .
•       Steroid injection into the tender area may give temporary relief but repeated injections are not recommended.
•      Surgery: A few patient may need surgery to remove the heel spur or detach the plantar fascia from the heel bone. The surgery itself has its complications and long term side effects.