Heel Pain: Plantar Fasciitis or Achilles Tendinitis?

Few shoes capture the laid-back style of summer better than flip flops. We can’t help but love them, as they remind us of relaxing by the pool, or a fun-filled day at the beach. Truth be told, prolonged periods of wearing flip flops can wreak havoc on your feet and may even cause you a trip to an orthopedic surgeon. They can be the culprit of heel pain, which is a common foot and ankle complaint. Conditions like plantar fasciitis and Achilles tendinitis present similar symptoms, but are, in fact, two separate conditions requiring different treatments. For this reason, it’s important you seek help from a foot and ankle specialist to properly diagnose your heel pain.

Achilles Tendonitis
The Achilles tendon is a strong fibrous tissue that connects the calf muscle to the heel bone. This tendon is used when you walk, run, jump, or stand on the balls of your feet. With continuous use during physical activity such as running, inflammation can occur which causes swelling. Tendonitis causes pain, swelling, and stiffness in the back of the heel. A common complaint is pain in your foot after sitting for long periods of time or going up stairs.

Symptoms
• Pain or inflammation of the back of the heel, especially when walking or running
• Inability to flex your heel easily
• Tightness in your calf muscle

Causes
• Repeated physical activity
• Sports requiring swift movement and quick stops
• Increased mileage or hill workouts
• A sudden increase of physical activity without proper training
• If you have Rheumatoid arthritis, you are more likely to be at risk

Treatment
For mild cases, home remedies such as ice, stretching, rest, and proper shoes may help improve this condition. Dependent on the severity of pain, a heel lift or shoe adjustment may be necessary to help reduce tension on your heel. With moderate to severe cases a walking boot may be the best option to prevent your heel from moving. Avoid flip flops or sandals of any kind. Dr. Sara E. Zelinskas recommends wedge-like shoes for the arch support. For men this means supportive tennis shoes.

Plantar Fasciitis
If you wake up in the morning with your first steps causing heel pain, you likely have plantar fasciitis. This painful condition occurs when the fascia tissue is under a lot of strain. Your plantar fascia is a thick band of connective tissue that stretches from your heel bone to your toes. It supports your arch and is what puts the spring in your step.

“Probably the most common condition I treat patients for is plantar fasciitis, which accounts for 2 million patient visits per year and is the top reason people see a foot and ankle specialist,” said Sara E. Zelinskas, DPM, ABFAS of TPMG Foot and Ankle in Virginia Beach.

Symptoms
• A sharp, burning pain when you take your first steps in the morning or after you’ve been sitting for a while
• Pain in the arch of your foot
• A swollen heel
• Increased pain after exercise
• A tight Achilles tendon

Causes
• High-arched feet or flat feet
• You’re an athlete
• You’re a runner or jumper
• You work on a hard service
• Standing for prolonged periods of time
• You exercise without properly stretching your calves.
• Wearing shoes without arch support – flip flops are a common culprit

Treatment
Surgery is rarely needed to alleviate this condition. In fact, the American Academy of Orthopaedic Surgeons (AAOS) says over 98 percent of people improve without surgery. For mild to moderate plantar fasciitis, Dr. Zelinskas advises you to rest and ice your foot twice a day. Stretch once a day – especially after exercise – using a stick or foam roller to roll out your calf muscle. Orthotics, a heel lift, or shoe adjustment may be prescribed dependent on the severity. Other options include night splints, cortisone injections, and PRP (platelet-rich plasma) injections if your pain is moderate to severe.

Takeaways
Avoid pushing through the pain as this will just make the condition worse. For Achilles tendonitis this is particularly a bad idea because you have the chance of rupturing the Achilles tendon. Avoid or limit incline plyometric exercises, running, or hill workouts until pain has reduced. Seek help from a foot and ankle specialist to properly diagnose your condition to prevent more aggressive forms of treatment.

Footwear Recommendations
Normal Foot Type: Oofos Shoes
Summer Sandals: OluKai, Chacos, Bionica
Tennis Shoes: Seek out a running store in your area. Ask for a gait analysis to see which shoe is right for you based on your foot type.

Sara E. Zelinskas, DPM

About Dr. Sara Zelinskas

Sara Zelinskas, DPM, ABFAS, is a board certified foot and ankle specialist at TPMG Foot and Ankle in Virginia Beach. In addition to her training in foot and ankle surgery, Dr. Zelinskas has specialized training in sports medicine and dermatopathology, a subspecialty disciple of dermatology focused specifically on skin disorders of the foot and ankle resulting from skin diseases, cancer, athletes foot, and eczema. Dr. Zelinskas focuses on the needs of each individual patient to help them achieve their individual training goals, whether as a weekend warrior or budding marathon runner. Her goal is to keep her patients active by providing guidance on appropriate training and injury prevention, and through surgical intervention, when necessary.


Foot and Ankle Care at TPMG

TPMG foot and ankle specialists practice at offices in Newport News, Williamsburg, and Virginia Beach. TPMG’s board certified foot and ankle surgeons are experienced in the surgical and non-surgical treatment of common and complex foot and ankle problems, from ankle sprains to total ankle replacements. Utilizing the latest techniques, TPMG foot and ankle specialists provide completed foot and ankle care to help patients return to function and the activities they enjoy.

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