Typical heel pain usually presents itself as a sharp or achy discomfort on the bottom of the heel. It often feels like a bruised heel and gets progressively worse and more frequent.

Heel pain is most often caused by an inflammation of a ligament that inserts into the bottom of the heel.  This inflammation is a condition called plantar fasciitis.

A heel spur may also be present.  Surprisingly it typically is not the cause of the pain.

Heel pain may also be due to other causes such as a stress fracture, injury, tendonitis, arthritis, nerve irritation, or a bone cyst.

How does heel pain form?
Heel pain and heel spur syndrome generally develops from a skeletal and muscle imbalance in the foot and leg. Heel pain occurs most frequently in a foot that flattens or pronates when you walk, but may also be seen in those feet with an excessively high arch. This places an excessive strain on the “Plantar Fascia”, a broad ligament that spans the arch of the foot connecting the heel to the ball of the foot.  As this ligament undergoes stress and strain, it becomes inflamed and causes pain. Strain is also placed upon the soft tissue within the arch, including the muscles and ligaments that attach to the heel. As the imbalance and soft tissue strain persists, pain and spurring ensues.

Contributing factors may include being overweight, genetics, wearing non-supportive shoes, and may form from a difficult lifestyle such as working on cement floors all day. This condition is more commonly seen in males and females in their thirties and forties. As one gets older and gains weight, the arch has a tendency to collapse.

Symptoms
The heel pain and heel spur syndrome patient is first seen in our office complaining of a sore painful heel. Some patients will get arch cramping as well. The most common complaint is that the heel hurts with the first couple of steps in the morning or after rest. Frequently, the heel loosens up with walking. The heel also becomes painful with excessive activity, especially working on concrete floors, standing or walking for extended hours, or working on ladders. Some patients get pain just when driving a car and some have cramping, soreness, and overall tiredness in the arch of the foot.

Diagnostic Tests
Most of the time, heel pain and heel spur syndrome can be diagnosed by the doctor manipulating the foot and with an accurate history and physical. X-ray will easily diagnose the presence of a heel spur, which is not found in all patients with heel pain. Also, here at Foot First Podiatry, our office utilizes state-of-the-art equipment such as Diagnostic Ultrasound. This enables our office to measure the exact amount of inflammation present in the heel, as well as track the healing process.

Non-Surgical Approach:

Our non-surgical treatment plan for plantar fasciitis and heel spur syndrome is extremely effective and rarely we need to proceed to surgical intervention. Our goal is to offer the fastest, most precise way to relieve the pain.

We recommend at home treatments which includes:

• Exercises that stretch out the calf muscles help ease pain and assist with recovery.
• Avoid going barefoot.  When you walk without shoes, you put undue strain and stress on your plantar fascia.
• Putting an ice pack on your heel for 10 minutes several times a day helps reduce inflammation.
• Limit activities.  Cut down on extended physical activities to give your heel a rest.
• Shoe modifications.  Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
• Lose weight.  Extra pounds put extra stress on your plantar fascia.

Our in office treatment includes:

• Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
• Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis. These orthotics usually will prevent reoccurrence of heel pain.
• Injection therapy. Corticosteroid injections are used to help reduce the inflammation and relieve pain.
• Physical therapy. Physical therapy measures such as ultrasound and muscle stimulation may be used to help provide relief.

Surgical Approach:

The surgical treatment is usually not considered unless heel pain is unrelenting and all conservative treatments have been used for a minimum of three to six months. Surgical treatment usually consists of relieving the strained “plantar fascia” ligament thus alleviating stress from the heel. Severe cases may also require the cutting and removal of the heel spur itself.