Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) which place too much stress on the heel bone and the soft tissues that attach to it. Characteristically, the patient complains of pain on the bottom of the heel which is worse with the first few steps in the morning and after rest. The pain tends to subside during the day, however worsens with increased activity. The athlete may experience pain following vigorous exercise.
The plantar fascia is a band of connective tissue that runs from the heel to the ball of the foot supporting the arch. If the arch flattens excessively (pronation), the foot is lengthened placing tension on the plantar fascia. If the arch remains taut, small tears in the plantar fascia may occur causing inflammation of this band of connective tissue (plantar fascitis). When the plantar fascia tears near the heel bone, a heel spur may develop. A high arched foot (cavus foot type) may have a shortened plantar fascia which may also exacerbate heel and arch pain.
An x-ray may be taken to confirm a heel spur, however, the size of the spur is usually not proportional to the symptoms. Other causes of heel pain include arthritis, nerve entrapment, and stress fractures. An inflamed growth plate is a common cause of heel pain in children.
Several steps one can take to avoid heel pain include
- Do not wear shoes with excessive wear on heels or soles
- If obese, lose weight
- Wear shoes that fit properly, have shock-absorbent soles, supportive heel counters, and are appropriate for each type of activity
- Stretch and warm up before and after exercise. Pace yourself.
Treatment of heel pain involves eliminating the cause of the pain thus reducing the inflammation. We have been able to avoid surgery in greater than 90% of patients complaining of heel pain with the use of a custom orthotic device. The advent of new materials and methods of fabrication allow orthotics to be worn in most forms of footwear including dress shoes, running shoes, cowboy boots, and even high heels.
With the foot held in its correct position, a laser scan of the foot is taken according to the patient’s individual needs. The scan is electronically sent to a podiatric laboratory for fabrication of custom-molded orthotics.
Additional forms of treatment include: anti-inflammatory medication either by mouth or injection, taping, over-the-counter arch supports, and physical therapy. Most heel pain sufferers can expect relief without the need for surgery, however, if needed, and Endoscopic Plantar Fasciotomy may be performed. This innovative procedure is minimally invasive offering early resumption of activities.
Feet that hurt make it difficult for us to perform normal daily activities making exercise less likely. Treatment of heel pain varies depending on the type, cause, and severity of the condition. Today there are highly effective forms of treatment which may reduce or eliminate the pain all together.