HEEL PAIN
PLANTAR FASCIITIS

The most common cause of  pain in the bottom of the heel, is plantar fasciitis (inflammation of the plantar fascia). The plantar fascia is a band of fibrous tissue which runs along the bottom of the foot, from the heel to the toes. It is just below the skin and helps support the arch. Inflammation over a period of time causes the body to deposit calcium where the plantar fascia inserts into the heel bone. This results in the appearance of a bony heel spur on x-ray. The spur itself is not the source of the pain. Heel pain should be evaluated by your podiatrist.

Symptoms

· Sharp pain on the bottom of the heel

· Often worse on arising in the morning and after resting 

· Aggravated by  weight bearing and walking

· Pain may limit activities

· Most common in middle-aged and overweight adults

Causes

· Excessive load on the foot from obesity

· Excessive flattening of the arch on weight bearing

· Tight plantar fascia

· Over pronation of the foot (a complex motion including outward rotation of the heel and inward rotation of the ankle).

What you can do

· Application of ice to the heel area after prolonged activity

· Wear supportive shoes with a stiff heal counter (the part of the shoe which wraps around the heel) and a good arch. A well made running or walking shoe is a good example.

· Sometimes a shoe with a moderately high heel will relieve pressure on the fascia

· Stretching and strengthening exercises will stretch the plantar fascia and strengthen the small intrinsic muscles which stabilize the arch. This should not be attempted when the heel is sore.

· Over the Counter anti-inflammatory medications containing ibuprofen or aspirin when tolerated

What the doctor may do

· Prescription doses of anti-inflammatory medication

· Inject powerful anti-inflammatory medication to calm inflammation around the painful area

· Apply taping and padding to relieve strain on the plantar fascia

· Administer physical therapy (eg. ultrasound, cold laser)

· Control foot function with an orthotic

· Prescribe special splints to help stretch the fascia

· Surgical release of the plantar fascia and excision of the heel spur (rarely required).

Other causes of heel pain

· Various types of arthritis

· Trauma to the heel

· Inflammation of the tendons around the heel

· Heel Neuroma (benign tumors of the nerves around the heel)

· Abnormality in the shape of the heel bone

· Foreign body in the heel (eg. splinter)