Heel Pain

Heel pain is one of the most common problems we see in our podiatry office. It is like the common cold for a Podiatrist. The majority of patients have a problem called plantar fasciitis. However, there are other causes. So a full exam is recommended to rule out these other causes.

Plantar Fasciitis is an inflammation of the plantar fascia. The plantar fascia is a ligament that runs along the bottom of the foot from the heel to the ball of the foot and even has slips that go into the toes. The main job of the plantar fascia is to hold the arch up. As you walk and your arch falls it puts extra strain on the plantar fascia. This causes small tears and eventually thickening of the plantar fascia. The thickening causes pain on the bottom of the heel.

Plantar Fasciitis is often accompanied with a heel spur. This is an outgrowth of the heel bone. The outgrowth is caused by the extra tension (pull) of the plantar fascia where it attaches to the heel. Commonly, people think that the pain is actually caused by the spur. Rarely, the spur may become fractured and cause pain, but normally the spur is painless. The pain is actually coming from the plantar fascia.

A second cause of pain in the bottom of the heel is a stress fracture of the heel bone. This bone is called the Calcaneus. With repeated stress from walking or running stress fractures may occur. The Calcaneus may also be fractured with injury, but this requires a significant amount of force. The fractures are usually caused by a fall. The pain of a stress fracture often feels as though it’s coming up the sides of the heel rather than pinpointed on the bottom. Stress fractures are more difficult to diagnose. Often they are not seen under normal x-rays. An MRI may be required to diagnose a stress fracture of the heel.

A third cause of pain in the bottom of the heel is a bursa. A bursa is a small pocket of inflammation tissue. These pockets form for a multitude of reasons. One reason would be decreased in the fat pad of the heel causes the body to form a cushion as a defense mechanism. This cushion becomes inflamed. Often these can be seen under ultrasound.

Nerve problems can also be a cause of heel pain. Entrapment of a nerve that comes around the inside of the ankle can be perceived as pain in the bottom of the heel. The disorder is called tarsal tunnel syndrome, and is similar to carpal tunnel syndrome. It is due to the collapsing of the arch of the foot, and pinching of the nerve to the bottom of the foot.

There are several other disorders which can cause pain on the bottom of the heel. Still the most common cause is plantar fasciitis. If you begin to have heel pain you should come to our office for an exam. There are many treatment modalities that may be used to resolve your pain and get you back to your normal activities.