Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress, fracture, tendonitis, arthritis, nerve irritation, or rarely a cyst. Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is best trained to distinguish between all the possibilities and determine the underlying source of your heel pain.
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed-resulting in heel pain.
• Pain on the bottom of the heel
• Pain that is usually worse upon arising
• Pain that increases over a period of months
People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia.
• You have high arches or flat feet.
• You walk, stand, or run for long periods of time, especially on hard surfaces.
• You are overweight.
• You wear shoes that don’t fit well or are worn out.
• You have tight Achilles tendons or calf muscles.
• Your feet roll inward too much when you walk (excessive pronation).
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:
• Stretching exercises: Exercises that stretch out the calf muscles help ease pain and assist with recovery.
• Avoid going barefoot: When you walk without shoes, you put undue strain and stress on your plantar fascia.
• Ice: Putting an ice pack on your heel for 10 minutes several times a day helps reduce inflammation.
• Shoe modifications: Wearing supportive shoes that have a good arch support and a slightly raised heel Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce pain and inflammation.
• Lose weight: Extra pounds put extra stress on your plantar fascia.
• Padding and strapping: Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
• Orthotic devices: Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
• Injection therapy: In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
• Removable walking cast: A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
• Night splint: Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
Although most patients with plantar fasciitis respond to non-surgical treatment, approximately 80%, the remaining 20% may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered.