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Pain in the heel is extremely common. With proper treatment, most patients can be relieved of their symptoms. Select from the following articles:
Plantar Fasciitis
The most common cause of heel pain is a pull on the heel bone exerted by the muscles and ligaments (plantar fascia shown in illustration above) that support the arch of the foot. This is an overuse condition similar to bursitis of the shoulder or tennis elbow.
Plantar fasciitis is typically very painful in the morning during the first few steps, after sitting and again at the end of the day.
Causes
Plantar Fasciitis can be caused by:
- being overweight
- shortened heel cord and calf muscles
- relaxation of the arch of the foot
- overactivity
- infrequently, a heel spur forms at the attachment of the muscles to the heel bone; these heel spurs are not the cause of the pain.
Treatment
Treatment of plantar fasciitis is usually performed in stages according to the duration and degree of pain. Treatment may take many months if the condition has been longstanding.
Treatment usually begins with anti-inflammatory medication, shoe modification, temporary limitation of activities, weight loss and heel cord stretching. Also, night splints are often helpful to stretch the plantar fascia.
An arch support (orthotic) may also be helpful, especially if you have a flat foot. If the problem continues, the tender area occasionally may be injected with cortisone and a local anesthetic. For a difficult, chronic problem, a period of casting may be used to improve this condition.
Surgical treatment is rarely needed. If performed, it aims to partially release the plantar fascia and stimulate healing of the chronic inflammation. Removal of a heel spur, if it is large, may also be done at the time of surgery.
Painful Heel Pad Syndrome
Painful heel pad syndrome usually causes an aching discomfort under the heel bone (calcaneus) which is worse with standing, walking and toward the end of the day. More chronic fat pad pain results from walking on hard surfaces for long periods of time.
Causes
The fat pad can atrophy or waste away with age. An acute bruise of the fat pad can occur from a sudden increase in activiy on hard surfaces.
Treatment
- modifying activity to take weight off of the heel
- cushioning the heel as much as possible with running or walking shoes and heel pads
- no walking barefoot
Surgical treatment is not indicated for this condition. If the pain does not resolve with the treatment outlined above, sometimes a period of complete rest with crutches is necessary.
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