Heel Pain

Pain in the heel is one of the most common complaints that a foot specialist hears. The cause of heel pain is one of the most controversial subjects in the specialty. With treatment, however, most patients can be relieved of their symptoms.

The Cause

The most common cause of heel pain is the pull on the heel exerted by the muscles and ligaments that support the arch of the foot, an overuse condition similar to bursitis of the shoulder or tennis elbow.

Other causes of heel pain include: nerve entrapment, stress fracture of the heel bone, inflammatory diseases (such as rheumatism or gout), or a bruise of the fat pad under the heel.

The Condition

The pain typically is worse in the morning and with walking, but tends to get better through the day. Individuals with flat feet and tight heel cords are frequently affected, as are those who are overweight or overdo in athletics.

A heel spur is seen on X-ray in only about half the cases of heel pain. It forms at the attachment of muscles and ligaments to the heel. Heel spurs are not the cause of pain, however, many heel spurs are not painful at all.

The Treatment

Heel pain, even without treatment, will usually subside, but may take a long time. The treatment is done in stages, according to the duration of the problem and the degree of the pain.

STAGE I: Anti-inflammatory medications, shoe modifications, shoe inserts, temporarily limited activities and heel cord stretching will usually relieve the condition when it begins.

STAGE II: If the problem continues, the tender area can be injected with hydrocortisone and a local anesthetic. It also helps at this stage to tape the arch or use an arch support.

STAGE III: For the difficult, chronic problem, a cast can be tried. Either a removable type such as a slipper cast, a cast brace, or a standard walking cast. A night splint can also help.

STAGE IV: Surgery can be done if other treatments fail. The aim is to release tight ligaments, relieve nerve pressure, or do both. Removal of the spur can also be done at this time.