Heel Pain

There are a variety of causes of heel pain. Heel pain can occur on the bottom of the heel or the back of the heel. The most common heel pain occurs in the bottom of the heel. Frequently this pain is worse first thing in the morning or after having been at rest. It seems to come out of nowhere or feel like a stone bruise after having been on your feet for long periods of time. Patients often describe the pain as being sharp like stepping on a "spur" or a thorn. The pain may radiate into the arch of the foot or up into the calf muscle. On occasion, leg or foot cramps accompany the condition. Often associated with a spur identified on x-rays, the condition may be referred to as "heel spurs." A common contributing factor is tightness of the calf muscles.

The pain is caused by the pull of a very strong ligament that attaches into the bottom of the heel and fans out into the ball of the foot. This ligament, called the plantar fascia, acts as a bow string to help support the arch of the foot. It is like woven rope and does not stretch well. When something causes the arch to flatten, the ligament is stretched more than it can, and it pulls on the heel bone, causing pain. We call this plantar fasciitis. This pain often eases after a few steps as the ligament is forced to stretch. In severe cases the ligament can tear or rupture.

Home remedies should include soaking your feet in Epsom salts and warm water, taking an over-the-counter anti-inflammatory, heel cushions or shoe inserts, and calf muscle stretching. Wearing a good supportive shoe is very helpful. Surprisingly, wearing a shoe with a 1" heel may ease the pain.

When seeking professional help, expect to have an x-ray taken to assist in the diagnosis. Treatment is tailored to the patient. Treatment may include a prescription anti-inflammatory drug, a cortisone injection, orthopedic taping of the foot to support the arch,or perhaps custom-made insoles for your shoes called orthotics. When conservative treatment fails, an operative procedure may be required.

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