The Many Causes of Heel Pain

By Maryann Hartzell, DPM

The pursuit of optimal health is a daily quest. Regular exercise is indeed a benefit, but what happens when we do too much? We experience pain, our body’s way of telling us to slow down and rest. When this pain occurs in our heels there can be many causes. The most common cause is a heel spur or heel spur syndrome. A frequent symptom of heel spur syndrome is pain that begins from your first step in the morning and improves as the morning progresses.

Plantar fasciitis, is another condition known to cause heel pain. Plantar fasciitis is an inflammation of the plantar fascia. "Plantar" means the bottom of the foot; "fascia" is a type of connective tissue, and "itis" means inflammation. This translates into inflammation, pain, and possibly the growth of a bone spur at the point where the connective tissue is attached to the heel bone.

In addition to the plantar fasciitis, many patients may have a spur on the bottom of their heel bone. The actual heel spur does not cause the pain, it is caused by the inflammation surrounding the spur. Heel spurs are deposits of calcium that are the result of tension and inflammation at the plantar fascia attachment to the heel bone. When the plantar fascia is strained repeatedly beyond its normal length of extension, the soft tissue fibers of the fascia can tear or stretch.

Other possible causes/symptoms of heel pain:

• Excessive flattening of the arch or pronation. Some degree of pronation is normal and allows the arch to adapt to uneven surfaces and absorb shock when walking. As we walk, the outside of the heel contacts the ground first; this is followed by a shift in weight inward and then outward. Excessive inward motion can cause an abnormal amount of stretching on the ligaments and tendons that are attached to the bottom back of the heel bone. The feet act as shock absorbers for the body, and if not functioning optimally the end-result will be pain in the hips, knees, and lower back;
• Systemic arthritis, such as rheumatoid arthritis and gout, can also play a role and should be ruled out;
• A pinched nerve or neuroma can sometimes mimic heel pain. An enlarged area of bone in the back of the heel can become irritated by shoes, causing pain. This is described as a Haglund’s deformity;
• Achilles tendonitis can cause heel pain towards the back of the ankle. These symptoms usually occur when the tendon is stretched beyond its normal limit and inflammation develops. The inflammation can develop into a bone spur on the back of the heel bone;
• Trauma to the heel can cause a bone contusion or bruise; and lastly
• If the heel is stressed to its limit, a stress fracture can occur.

Heel pain is not uncommon among children between the ages of 8 and 13. Physical activities such as repetitive jumping and repeated sports seasons in cleated shoes can inflame the growth centers of the heels. The more active the child, the more likely the condition will occur. The growth plates need to be protected until the inflammation resolves. If heel pain occurs in this age group, podiatric care is necessary to protect the growing bone and to provide pain relief.

In conclusion, if pain and other symptoms of inflammation such as redness and swelling persist, you should limit normal daily activities and contact a doctor of podiatric medicine (DPM). The symptoms of plantar fasciitis and heel spurs generally improve with rest, ice, and stretching.

Your podiatric physician will perform a complete lower extremity examination to determine the cause of your symptoms. Diagnostic X-rays may be taken to rule out problems of the bone. Sometimes anti-inflammatory medications or injections are necessary to decrease the painful inflammation at the attachment of the plantar fascia. Often times, custom-molded orthotics are prescribed to support the plantar fascia and allow patients to return quickly to their active life-styles.

A custom molded, functional orthotic device may be prescribed for controlling excessive pronation, and for support of the ligaments and tendons attached to the heel bone. In most cases, functional orthotics prescribed by your podiatrist will effectively treat most heel and arch pain without the need for surgery. Surgery is utilized last and often can be avoided with conservative management and active patient participation in the care plan.