Heel Pain

Heel pain is one of the most common and persistent foot problems affecting men and women of all ages. It originates deep within the foot, directly on the heel bone, or within the foot’s connective tissue -- the fascia. Pain occurs when tissues become irritated or inflamed resulting in growth of small spurs on the heel bone.

Plantar fasciitis, the type of heel pain caused by chronic inflammation of the connective tissue extending from the heel bone to the toes, occurs most frequently in adults. Being overweight and wearing inappropriate footwear are common contributing factors. The pain is most noticeable after getting out of bed in the morning, and it tends to decrease after a few minutes and returns during the day as time on the feet increases.

Many patients attempt self remedies for heel pain, such as anti-inflammatory medications and over-the-counter heel pads, before seeking medical advice. To help diagnose the origin of heel pain, physicians take a thorough history to learn the time of day when the heel pain occurs, types of shoes worn most frequently, activity levels at work or during recreation, and if there has been any recent trauma to the area.

Not all heel pain, however, is caused by plantar fasciitis. It also can occur from inflammation of the Achilles tendon, bursitis, arthritis, gout, stress fractures, bone or soft tissue tumors, or irritation of one or more of the nerves in the region. Sometimes in such cases, heel pain could be a symptom of a serious medical condition that should be diagnosed and treated separately.

Clinical guidelines published by the American College of Foot and Ankle Surgeons help physicians diagnose and manage all types of heel pain and distinguish cases that should be treated conservatively from those that require more specialized care.

Non-Surgical Treatment Works
Initial treatment options for heel pain caused by plantar fasciitis include anti-inflammatory medications, padding and strapping of the foot and injections of corticosterioids. Patients also should stretch their calf muscles regularly, avoid wearing flat shoes and walking barefoot, use arch supports and heel cushions, and limit the frequency of extended physical activities.

Most patients with plantar fasciitis respond to non-surgical treatment within six weeks. If improvement occurs, initial therapy is continued until the heel pain is resolved. But if heel pain persists, the patient should be referred to a foot and ankle surgeon for further evaluation and more specialized treatment.

Treatments for Persistent Heel Pain
When non-surgical treatment fails to remedy heel pain, surgical options may be considered.

With several surgical and non-surgical treatment alternatives available, heel pain should not be tolerated as a consequence of aging, injury, disease or regular physical activity. For those with persistent heel pain, foot and ankle surgeons are the experts to consult for determining the most appropriate treatments. The surgical treatment options for plantar fasciitis are generally focused on release of the tight and chronically inflamed plantar fascia bands. This can be performed either thought a minimally invasive endoscopic approach or thought a small incision on the inside of the heel. Surgical treatment of other causes of heel pain are focused on addressing the underlying cause of the heel pain. Bone or soft tissue tumors can often be removed without causing much complication or requiring extended recovery. Nerve entrapments around the heel can easily be decompressed allowing for return to pain free ambulation in a short period after the surgery. Regardless of the underlying cause of the heel pain, a foot and ankle surgeon is the most appropriate physician to seen for evaluation and treatment of the pain.

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