Heel Pain

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 and 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 and 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 and 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 and 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.