heelsOne of the most common foot problems seen by physicians is heel pain.  Heel pain that occurs in adult patients is most commonly caused by a condition known as plantar fasciitis.  This condition is sometimes accompanied by a heel spur.

Heel pain can also be caused by other factors, such as:

  • stress fracture
  • tendinitis
  • arthritis
  • nerve entrapment
  • cyst in the heel bone

It is important to see an appropriate specialist for heel pain because there are so many things that can cause it.  The specialist will be able to order the appropriate studies, distinguish between the possibilities, and determine what is causing the heel pain.

What causes plantar fasciitis?
This problem is caused by an inflammation (swelling) of the plantar fascia (a band of tissue/ligament that extends from the heel to the toes) on the bottom of the foot. Several factors contribute to plantar fasciitis.  These include:

  • having a very high arched foot or a flat foot
  • wearing non-supportive footwear on hard-to-flat surfaces for prolonged periods of time
  • physical factors such as obesity

What are the symptoms of plantar fasciitis?
Symptoms usually include pain on the bottom of the heel.  The pain is usually worse upon arising in the morning or after sitting for a period of time. The pain will generally decrease after a short period of walking.  The pain usually becomes worse over a period of months if not treated.

How is plantar fasciitis diagnosed?
Diagnosis is made after the specialist makes a thorough physical examination of the foot, takes note of the history and course of the problem, and orders appropriate diagnostic tests.  These tests may include X-rays, bone scans, or magnetic resonance imaging (MRI) when needed.  Occasionally, spurs on the bottom of the heel will be noted on X-rays; this is not usually the source of the pain.

How is plantar fasciitis treated?
Treatment of plantar fasciitis usually begins with elimination or reduction of the inflammatory syndrome via oral and/or injectable anti-inflammatories.  Additional treatments may include:

  • avoidance of walking barefoot
  • massage therapy
  • ice application to the area
  • limited physical activity for a time
  • using appropriate inserts or orthotics
  • modifying shoe gear
  • losing weight

Occasionally, if none of the above solutions work, surgery may be an option. In general, any surgery should be avoided until all of the above options have failed.

Heel pain can be treated conservatively without surgical intervention.  Remember that once pain has been alleviated, you may still need to continue appropriate supportive shoes and stretching exercises to prevent recurrence.