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 or nerve irritation. Because there are several potential causes, it is important to have heel pain properly diagnosed.

The most common cause of heel or arch pain is caused by a painful stretching or micro-tearing of the plantar fascia. The plantar fascia is a fibrous or tendon-like structure that courses along the bottom of the foot connecting the toes and calcaneus or heel bone.

During normal conditions, the fascia is flexible and strong. The fascia is partially responsible for the strength and flexibility of the arch and is required for normal walking. However due to factors such as abnormal stress, excessive weight, age, or improper foot support, the fascia can become weakened, irritated or inflamed. If the foot flattens excessively or becomes unstable at critical times during the gait cycle, the attachment of the plantar fascia onto the calcaneus may begin to stretch and pull away from the calcaneus. This painful condition is called plantar fasciitis.  After many years a heel spur may develop on the bottom of the calcaneus in addition to plantar fasciitis.

·     Heel spurs are visible on a lateral view x-ray of the foot. X-rays sometimes reveal very large heel spurs that do not produce pain. It is not the bone, but rather the inflammation of the fascia attaching to the heel which causes discomfort.

·     The onset can be  gradual, yet many people report the pain during the first steps onto the floor in the morning  for about ten minutes, or after extended resting periods during the day.

·     You may experience plantar fasciitis after a sudden increase in activity, weight gain or a recent change in footwear.

Cause

·     The most common cause is abnormal or excessive internal motion of the foot.

.     During resting or non-weight bearing periods, the plantar fascia shortens.  When body weight is rapidly applied to the foot the fascia must stretch and quickly lengthen, causing micro-tears in the fascia.

·     Hypermobility, (excessive internal motion) of the foot can induce future or coexisting problems involving the knee, hip, sacroiliac joint or the low back region.

Treatment

·     Plantar fasciitis and calcaneal heel spurs usually can be controlled with conservative or non-surgical treatment when treated early.

.     Although the development of plantar fasciitis takes a long time, we tend to pay attention to it when the pain has become significant. In general, the longer the pain has been present, the longer it will take to resolve.

.     Although soft heel materials or soft arch supports appear to cushion the heel they do not address the problem of foot support which initially caused the problem. Therefore, with soft heel cushions, the painful heel tends to return.

·     An orthotic (a custom-made shoe insert) should be used to stabilize the foot.

·     The role of the orthotic in these conditions is to prevent excess pronation and rapid excessive lengthening of the plantar fascia. The orthotic control limits the micro-tearing of the plantar fascia, thereby decreasing the pain.

.     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.

.     In addition to the use of foot orthotics, steroid (cortisone) injections, changing shoes, foot taping, and physical therapy is also helpful. Significant weight reduction is important.

.     No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes and using orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

.     Extracorporeal Shockwave Treatment

      If you have chronic heel pain or heel pain that has not been responsive to other treatments, there is a new non-surgical treatment that was recently approved by the FDA. ESWT (extracorporeal shockwave treatment) uses strong electrohydraulic acoustic (sound) energy that triggers the body's natural repair mechanism. This treatment method is safe, effective and requires a very short recovery period compared to older surgical techniques. ESWT requires only a local anesthetic. For more information, visit www.unitedshockwave.com

   ESWT Treatment

.     In some cases, if conservative care is ineffective, a small percentage of patients require heel spur surgery.

Return to Foot Topics