The heel bone is the largest of the 26 bones in the human foot. But while it is a large, strong bone, it is often injured, and this pain can be quite disabling at times. Heel Pain
can occur in the front, back, sides or bottom of the heel. That the heel is commonly
injured is not surprising, perhaps, given the amazing amount of stress it must endure during a day. Indeed, it is one of the most common injuries of the foot; we see some variation of heel pain in
our offices an average of 5 or 6 times per day.
Heel pain can have many causes but the vast majority is caused by plantar fasciitis. Plantar means, ?bottom of the foot.? Fascia is a ligament or ?bundle? of ligaments. The plantar fascia is the
thick ligament that helps to hold up the foot and provide spring in our step. Plantar fasciitis is an inflammation of the plantar fascia and causes more than 90% of heel pain among adults in the US.
Plantar fasciitis can be acute, that is, as simple strain of the ligament but often is chronic, hanging on for months if not years. Why does that happen? The answer is poor foot mechanics, the foot
sinking down too far allowing the plantar fascia to overstretch with each step taken.
The heel can be painful in many different ways, depending on the cause. Plantar fasciitis commonly causes intense heel pain along the bottom of the foot during the first few steps after getting out
of bed in the morning. This heel pain often goes away once you start to walk around, but it may return in the late afternoon or evening. Although X-ray evidence suggests that about 10% of the general
population has heels spurs, many of these people do not have any symptoms. In others, heel spurs cause pain and tenderness on the undersurface of the heel that worsen over several months. In a child,
this condition causes pain and tenderness at the lower back portion of the heel. The affected heel is often sore to the touch but not obviously swollen. Bursitis involving the heel causes pain in the
middle of the undersurface of the heel that worsens with prolonged standing and pain at the back of the heel that worsens if you bend your foot up or down. Pump bump, this condition causes a painful
enlargement at the back of the heel, especially when wearing shoes that press against the back of the heel. Heel bruises, like bruises elsewhere in the body, may cause pain, mild swelling, soreness
and a black-and-blue discoloration of the skin. Achilles tendonitis, this condition causes pain at the back of the heel where the Achilles tendon attaches to the heel. The pain typically becomes
worse if you exercise or play sports, and it often is followed by soreness, stiffness and mild swelling. A trapped nerve can cause pain, numbness or tingling almost anywhere at the back, inside or
undersurface of the heel. In addition, there are often other symptoms, such as swelling or discoloration - if the trapped nerve was caused by a sprain, fracture or other injury.
Your doctor will perform a physical exam and ask questions about your medical history and symptoms, such as have you had this type of heel pain before? When did your pain begin? Do you have pain upon
your first steps in the morning or after your first steps after rest? Is the pain dull and aching or sharp and stabbing? Is it worse after exercise? Is it worse when standing? Did you fall or twist
your ankle recently? Are you a runner? If so, how far and how often do you run? Do you walk or stand for long periods of time? What kind of shoes do you wear? Do you have any other symptoms? Your
doctor may order a foot x-ray. You may need to see a physical therapist to learn exercises to stretch and strengthen your foot. Your doctor may recommend a night splint to help stretch your foot.
Surgery may be recommended in some cases.
Non Surgical Treatment
Treatment of plantar fasciitis is usually performed in stages according to the duration and degree of pain. Treatment may take many months if the condition has been longstanding. Treatment usually
begins with anti-inflammatory medication, shoe modification, temporary limitation of activities, weight loss and heel cord stretching. Also, night splints are often helpful to stretch the plantar
fascia. An arch support (orthotic) may also be helpful, especially if you have a flat foot. If the problem continues, the tender area occasionally may be injected with cortisone and a local
anesthetic. For a difficult, chronic problem, a period of casting may be used to improve this condition. Surgical treatment is rarely needed. If performed, it aims to partially release the plantar
fascia and stimulate healing of the chronic inflammation. Removal of a heel spur, if it is large, may also be done at the time of surgery.
Surgery to correct heel pain is generally only recommended if orthotic treatment has failed. There are some exceptions to this course of treatment and it is up to you and your doctor to determine the
most appropriate course of treatment. Following surgical treatment to correct heel pain the patient will generally have to continue the use of orthotics. The surgery does not correct the cause of the
heel pain. The surgery will eliminate the pain but the process that caused the pain will continue without the use of orthotics. If orthotics have been prescribed prior to surgery they generally do
not have to be remade.
Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising. Wear comfortable, properly fitting
shoes with good arch support and cushioning. Make sure there is enough room for your toes.