Heel pain

Heel pain is most commonly caused by plantar fasciitis, a chronic (ongoing) overuse injury of the thick band of tissue on the sole of the foot, which is known as the plantar fascia.

Symptoms

The heel pain of plantar fasciitis is often worst with the first few steps in the morning and can increase with standing and after exercising. The pain usually lessens with activity, but returns with inactivity.

Causes of heel pain

With repeated activity on our feet, the plantar fascia can become tight and cause persistent traction (tugging) on its attachment point into the heel bone, and inflammation and pain may develop at this site. This painful condition is known as plantar fasciitis.

Biomechanical abnormalities that cause the foot to excessively pronate (roll in) on walking, tightness or weakness of the calf muscles, and abnormal functioning of the big toe, are the underlying contributors to many cases of plantar fasciitis.

Heel spurs

Sometimes painful outgrowths of bone called heel spurs (also known as a calcaneal spur) form where the plantar fascia joins the heel bone, however, these are due to the pulling of the plantar fascia on the bone, and are not the primary source of the heel pain.

foot showing plantar fascia and heel spur

Heel spurs do not always cause pain and often are discovered incidentally on X-rays taken for other problems. Heel spurs can occur at the back of the heel and also under the heel bone on the sole of the foot, where they may be associated with  plantar fasciitis.

Treatment of heel pain

Heel pain may be associated with a heel spur, however the heel pain is usually due to plantar fasciitis, rather than a heel spur, so treatment is usually directed at the plantar fasciitis itself.

Treatment for plantar fasciitis may include rest from aggravating activities such as long walks and running, calf muscle stretching, applying ice, anti-inflammatory medicines and weight loss to reduce stress on the feet. Supportive footwear such as running shoes that have a stiff heel counter and a good midsole support are recommended. If necessary, foot supports, strapping, night splints or orthotics may be recommended to temporarily correct biomechanical abnormalities of the foot.

Occasionally, in severe cases, a long leg walking boot may be recommended. Other forms of treatment for resistant cases of plantar fasciitis are available and are sometimes successful. These include ESWT (extracorporeal shock wave treatment) and PRP (platelet rich plasma) injections. Surgery is very rarely recommended and only after other measures fail.

References

1. Mayo Clinic. Heel pain. Last reviewed 21 Aug 2010. http://www.mayoclinic.com/health/heel-pain/MY00081 (accessed Feb 2013).
2. Mayo Clinic. Heel spurs: do they always cause pain? http://www.mayoclinic.com/health/heel-spurs/AN01966 (accessed Feb 2013).
3. Mayo Clinic. Plantar fasciitis.Last reviewed 15 March 2011. http://www.mayoclinic.com/health/plantar-fasciitis/DS00508 (accessed Feb 2013).
4. Australian Podiatry Association. Heel pain. http://www.podiatry.asn.au/knowledgebase.asp?pid=15&id=20 (accessed Feb 2013).
5. BMJ. Patient leaflets. Heel pain. Last reviewed 31 Oct 2012. http://bestpractice.bmj.com/best-practice/pdf/patient-summaries/532382.pdf (accessed Feb 2013).
6. MedicineNet.com. Heel spurs and plantar fasciitis. Reviewed 24 July 2012. http://www.medicinenet.com/heel_spurs/article.htm (accessed Feb 2013).
7. Brukner P, Khan KQC. Brukner & Khan's Clinical Sports Medicine. McGraw-Hill
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