Why Does My Heel Hurt?

Heel pain is one of the most common foot problems we encounter. In one office study we performed, we found 2200 patient visits in one year, due to heel pain. By far and large, this is usually due to a condition called plantar fasciitis. In recent years, this has been renamed plantar fasciosis because it involves more than one part of the heel. The patient who suffers from this condition usually has severe pain in the heel when they first step out of the bed in the morning. They will walk on the side of their foot or on tiptoes until it stretches out. Once they sit for a while it may become less painful, but as soon as they get up, the same intense pain occurs. Most people with this problem, can hardly believe how painful this can be! In general, they will relate no incidence of an injury. However, some may recall a recent day of increased activity, or new (cheap) shoes or sandals. We see an increase around state fair time. Our arch is supported by several ┬ástructures, which includes a band of tissue called the plantar fascia. Plantar simply means “the bottom of the foot”, much like the palm is the bottom of the hand. The fascia is a strong ligament that stretches from the heel to the base of the toes. When the arch is under an increase strain, this band of tissue may sustain small tears off of the bottom of the heel. Before it has a chance to completely repair itself, we get up the next day and tear it away a little more. This process goes on day after day, until the inflammation becomes too much to bear. In some patients, this may start to include the small muscle of the arch, and even the heel bone itself. Taking an occasional aspirin or motrin will not help much. When we see this patient we will get an xray to be sure there is no bone stress injury, but often times will see a small spur that has developed. The spur is never the cause of the pain, but is a result of the tissue injury. Treatment will include what you may expect: rest, support, rehabilitation, and support to allow the tissue to heal. This will be in the form of soft bracing, orthotics(arch supports), anti-inflammatory medicine, and stretching exercises. In cases that seem resistant to care, we may add a steroid injection, formal physical therapy, and even a special removable boot that acts like a cast. Remember, the goal is to heal a torn ligament, and rehabilitate an injured part that you keep walking on every day. It is rare that anyone will ever need surgery for this problem, but on a few recalcitrant cases this may need to be considered. If this sounds like your problem, you may need to make an appointment with one of our podiatrists.