By David Sabet, D.P.M.
Most people describe a deep aching pain on the bottom of the foot, underneath the heel bone. The pain is usually worse first thing in the morning or after prolonged sitting (even when riding in a car). Walking often eases the pain, but standing will make it worse. Going barefooted or wearing shoes will increase the pain, while a heel lift or moderate heel will decrease the symptoms.
While doctors debate causes we do know one thing with certainty; Heel spurs alone DO NOT produce heel pain. Other than that, heel pain can be a result of many conditions including:
- An inflamed ligament, nerve or soft tissue sac
- Loss of cushioning on the bottom of the heel
- A foot shape (flat feet or high arches) which places stress on the heel
- Systemic health problems such as gout, infection and arthritis
A very strong ligament (the plantar fascia) attaches to the bottom of the heel bone and supports the arch. Beneath the heel bone is a thick, shock absorbent fat pad through which run vital nerves and blood vessels. If the fat pad thins (as it does in normal aging) excessive pressure is placed on the ligament, nerve and other delicate tissues. The foot is vulnerable to repetitive motion injuries. So any activity requiring the same action or movement for an extended period may lead to an overuse injury.
How the diagnosis is made
We do an examination of the foot to identify the tender areas. The blood and nerve supply entering the foot from the ankle is checked. Then you will be asked to walk while an analysis of your gait is performed. Most of the time, heel pain is the long term result of a foot problem which can be seen when you walk. X-rays are usually needed to rule out bone changes, arthritis or a hairline fracture of the heel bone. You may or may not see a spur. Remember, it is not the spur itself which hurts but the inflammation around the spur. Blood tests and other studies may be indicated. Since there is no specific test for heel pain several studies may be needed to confirm the diagnosis.
In some cases non-surgical treatment is successful, but it may take months.
- Anti-inflammatory medications such as aspirin, AdvilŪ or others can reduce the pain.
- Often prescription medications are more effective, especially if needed for a long period of time.
- Cortisone injections may help to calm the inflammation
- Prescription arch supports, called orthotics, are the mainstay of treatment. Made from a mold of the foot, the orthotic is worn in all of your shoes.
- For some people though, surgery is the only way to relieve the pain. A technique, called Endoscopic Plantar Fasciotomy allows the procedure to be performed though two tiny punctures in the heel. This technique allows for quicker recovery and a return to normal activities within a few weeks.
Heel pain, while common, is very debilitating and can turn an active person into a sedentary couch potato. Conservative measures are successful in the vast majority of cases. The exact treatment for you can only be determined after a thorough examination.