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There are many underlying causes of heel pain, and some physicians feel that it is probably more accurate to simply make a diagnosis of heel pain rather than try and define an absolute cause in every instance.
Incidence; Causes & Development
Plantar fasciitis occurs in both men and women, but is more common in women.
Women have a significantly higher incidence of heel spurs due to certain types of footwear that are worn on a regular basis.
Plantar fasciitis. Excessive stretching of the plantar fascia that leads to inflammation and discomfort can be caused by the following:- Over-pronation (flat feet) which results in the arch collapsing upon weight bearing
- A foot with an unusually high arch
- A sudden increase in physical activity
- Excessive weight on the foot, usually attributed to obesity or pregnancy. The incidence and severity correlate strongly with obesity.
- Improperly-fitting footwear.
Heel Spurs. Heel spurs develop as an abnormal growth in the heel bone due to calcium deposits that form when the plantar fascia pulls away from the heel.
Signs & Symptoms
Plantar fasciitis, the most common cause of heel pain, may have several different clinical presentations. Although pain may occur along the entire course of the plantar fascia, it is usually described as pain in the heel that occurs when taking the first few steps in the morning, with the symptoms lessening as walking continues. The pain is localized to an area that the examiner identifies as the medial calcaneal tubercle near the inside of the foot where the heel and arch meet. This bony prominence serves as the point of origin of the anatomic central band of the plantar fascia and three muscles between the heel and forefoot. The pain is located here since the weakest point of the plantar fascia is at its origin on this tubercle.
The pain is usually insidious, with no history of acute trauma. Many patients state that they believe the condition to be the result of a stone bruise or a recent increase in daily activity. It is not unusual for a patient to endure the symptoms and try to relieve them with home remedies for many years before seeking medical treatment.
Diagnosis & Tests
Plantar fasciitis is often referred to as "heel spur syndrome" in the literature and the medical community, but the label is a misnomer. This vague and nonspecific term incorrectly suggests that bony "spurs" are the cause of pain rather than an incidental X-ray finding. There is usually no correlation between pain and the presence or absence of bony growths and excision of a spur is not part of the usual surgery for plantar fasciitis.
Treatment & Prevention
The key for the proper treatment of plantar fasciitis is determining what is causing the excessive stretching of the plantar fascia. Common treatments include stretching exercises, plantar fasciitis night splints, wearing shoes that have a cushioned heel to absorb shock, and elevating the heel with the use of a heel cradle or heel cup. Heel cradles and heel cups provide extra comfort, cushion the heel, and reduce the amount of shock and shear forces placed during everyday activities.
Every time your foot strikes the ground, the plantar fascia is stretched. You can reduce the strain and stress on the plantar fascia by following these simple instructions: Avoid running on hard or uneven ground, lose any excess weight, and wear shoes and orthotics that support your arch to prevent over-stretching of the plantar fascia.
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Signs, symptoms & indicators of Heel Pain:
Risk factors for Heel Pain:
Recommendations and treatments for Heel Pain: | | | | | Drug |  Conventional Drug Avoidance | Cortisone injections should be avoided in the initial treatment of plantar fasciitis; they should be suggested only as supplemental treatment in patients who have resistant chronic plantar fasciitis after achieving adequate biomechanical control. These injections may provide only temporary relief and can cause a loss of the plantar fat pad if used injudiciously. |
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Homeopathy |
 Silica Cell Salt |
Physical Medicine |
Physical Supports and Devices| | When the cause is flat feet, an orthotic support with rear-foot posting and longitudinal arch is effective in reducing the over-pronation and allows the condition to heal. See your podiatrist to have an arch support fitted.
If you have usually high arches, which can also lead to plantar fasciitis, cushion the heel and use shock-absorbing footwear. |
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Surgery/Invasive |
 Prolotherapy |
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KEY | | Weak or unproven link |  | | Proven definite or direct link | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Bruise (Bruised, Bruising)
Injury producing a hematoma or diffuse extravasation of blood without breaking the skin.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. The body also needs calcium to carry nerve signals, keep the heart functioning, contract muscles, clot blood and maintain healthy skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Cup (Cups)
A unit of volume measurement equal to 8 fluid oz, or roughly 250ml. It also equals 1/2 pint, 1/4 quart and 1/16 gallon.
Excision
Surgical cutting away and/or taking out.
Heel Spurs
Also known as Plantar Fasciitis. There are no visible signs, but symptoms include severe pain on the bottom of the heel after rest (rising from bed or sitting); pulling your 'toes towards your nose' causes pain; firm pressure with the thumb indicates a deep tender spot in or around the middle of the sole of the heel. The plantar fascia is a tight ligament that stretches along the bottom from the heel bone to the ball of the foot. If small fibers of this connective tissue begin to tear away from the heel bone, the body responds by depositing calcium in an attempt to "glue" the detached fibers back on to the heel. Heel spurs ("bone spurs" or calcaneal spurs) can develop if the fascia is continuously under tension, and be reabsorbed by the body or become symptom-free when the tension is released.
Homeopathy (Homeopathic)
A system of medicine based on the belief that the cure of disease can be effected by minute doses of substances that, if given to a healthy person in large doses, would produce the same symptoms as are present in the disease being treated. Homeopathy employs natural substances in small doses to stimulate the body's reactive process to remove toxic waste and bring the body back into balance.
Insidious
A symptom or condition of gradual onset or development.
Plantar Fascia
The plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot, attaching at the inside bottom of the heel bone and extending to the forefoot.
Plantar Fasciitis
Plantar Fasciitis is an inflammation caused by excessive stretching of the plantar fascia, which can also lead to heel pain, arch pain and heel spurs.
Prolotherapy
A single or series of injections that stimulates the body to regrow, tighten, and strengthen ligaments or tendons. It is unequaled for pain relief and restoration of normal function for any body joint where connective tissue is weak or has been damaged.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: Apr 13, 2008
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