Heel pain can be the result of several different mechanisms. It can be caused by injury through misadventure or through stress fracture in which hairline fractures appear in the bone over time from simple wear and tear. This is more likely when large amounts of pressure being placed on it (say if you’re overweight). Heel pain can also come from other conditions such as dry flaky skin or an awkward gait. Other causes are arthritis, cysts, tendonitis or nerve irritation. However the most common cause of heel pain is plantar fasciitis, a condition that’s also known as heel spur syndrome (when a spur is present).

Plantar fasciitis describes the irritation and probable inflammation of the band of tissue that goes from the heel to the toes known as the plantar fascia. The symptoms include pain on the bottom of the heel which generally worsens as the foot is raised and that increases gradually over several months. The heel pain is also often worst after long periods of rest such as sleeping or sitting down, though walking can then help to alleviate the pain as it stretches the fascia. At least it’ll keep you active…

The causes of plantar fasciitis are many, but you will increase your chances of developing the condition if you spend a lot of time on hard flat surfaces without much support for your feet. If you spend a lot of time on your feet at work, or like to go jogging, then make sure you have supportive footwear to prevent it. Obesity will also make the condition more likely as the heavier you are the more pressure will be exerted on the heel.

Diagnosis will take place via a physical exam during which the doctor or surgeon will need your medical history to rule out other causes of the heel pain. They may also use x-rays, bone scans or MRI (magnetic resonance imaging) to check for stress fractures or tendon damage etc.

Once the heel pain is diagnosed as plantar fasciitis the patient will likely be given several treatment options and many of these things you can try yourself at home to see if it eliminates any pain. Patients are encouraged to perform exercises that stretch the calf muscles, such as touching the toes or raising up onto tip-toes. They will also be told to avoid going barefoot where possible and to ice the foot to counter inflammation. Similarly, anti inflammatory medications such as ibuprofen may also be recommended. They may also be given shoe modifications to help counter the problem or given pads or straps to alter the insole and soften impacts. Of course as is almost always the case on visits to the doctor, overweight patients will be advised to try losing weight.

If discomfort continues health professionals might consider injection therapy – where corticosteroid injections are administered straight into the plantar fascia to counter inflammation. Night splints can also be used to maintain a stretch on the calf and the foot throughout the night, as can walking casts to allow the heel to rest. Finally doctors might refer patients to a physical therapist.

Mack LeMouse

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