Heel pain is most commonly caused by plantar fasciitis/ fasciosis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis or nerve irritation. Because there are several potential causes, it is important to have heel pain properly diagnosed.
The most common cause of heel or arch pain is caused by a painful stretching or micro-tearing of the plantar fascia. The plantar fascia is a fibrous or tendon-like structure that courses along the bottom of the foot connecting the toes and heel bone.
During normal conditions, the fascia is flexible and strong. The fascia is partially responsible for the strength and flexibility of the arch and is required for normal walking. However due to factors such as abnormal stress, excessive weight, age, or improper foot support, the fascia can become weakened, irritated or inflamed. If the foot flattens excessively or becomes unstable at critical times during the gait cycle, the attachment of the plantar fascia onto the heel may begin to stretch and pull away from the calcaneus. This painful condition is called plantar fasciitis. After many years a heel spur may develop on the bottom of the calcaneus in addition to plantar fasciitis.
Heel spurs are visible on a lateral view x-ray of the foot. X-rays sometimes reveal very large heel spurs that do not produce pain. It is not the bone, but rather the inflammation of the fascia attaching to the heel which causes discomfort.
The onset can be gradual, yet many people report the pain during the first steps onto the floor in the morning for about ten minutes, or after extended resting periods during the day. You may experience plantar fasciitis after a sudden increase in activity, weight gain or a recent change in footwear.
- One possible cause is abnormal or excessive internal motion (pronation) of the foot. It is thought that this causes the fascia to be overused at critical moments
- During resting or non-weight bearing periods, the plantar fascia shortens. When body weight is rapidly applied to the foot the fascia must stretch and quickly lengthen, causing micro-tears in the fascia.
- Hypermobility, (excessive internal motion) of the foot can induce future or coexisting problems involving the knee, hip, sacroiliac joint or the low back region.
The cause may also be over-training, poor footwear selection, enviromental (e.g. working on hard flooring).
Treatment for heel pain, if plantar fasciitis is diagnosed will usually involve a combination of the following, based on severity and your podiatrist qualified judgement.
- Exercise review
- Anti inflammatory medication
- Footwear review
- Orthotic prescription link
- Local cortisone injection
- *Night splints
- Below leg casting
- Surgical opinion (rare)