HEEL PAIN
Heel pain is one of the most common complaints that bring people to the podiatrist.
Heel pain could be defined as any pain originating from the heel. Depending on the location, different problems manifest as a "heel pain". Anatomical areas include: Skin, bone, bottom, rear, Achilles tendon, below the ankle, right side or left side, along the bottom edges. So location is important in differentiating what the cause is. This could mean arthritis, tendinitis, nerve injury or entrapment, skin callous or skin fissure, blood vessel disorder, plantar fasciitis, or others.
Plantar Fasciitis
The most common manifestation of heel pain is pain at the bottom of the heel due to strain on the plantar fascia. This condition is termed "plantar fasciitis". An injury to this structure can hurt anywhere along its course, depending on location, but it is usually strained at the insertion at the heel bone. This is most commonly an overuse injury, rather than an acute (sudden) injury, although that can happen as well.
The plantar fascia is a thickened fascia at the bottom of the foot, from the heel to the toes, which acts to support the muscles in the foot. It also has a separate function, utilised normally to help arch the foot on heel off and create a solid foot to push off of, when walking. This can become strained when the position of the foot is not optimal and the plantar fascia is stretched and overworked. Classically, this is the foot that flattens and stretches out too much during walking, where there is too much motion in the foot when it is needed to be stable. This can be aggravated by poor shoes. High-arched feet can also develop plantar fasciitis due to strain, as well.
Typically, the heel pain hurts less while active than when first putting strain on it. "First step" pain, either in the morning when getting up, or after having been seated for a long time, is classic. This generally subsides the more you continue to walk on it and "warm up".
The arch-type of plantar fasciitis pain typically hurts after prolonged walking, and worsens as you continue to walk. This pain occurs in the midfoot arch area, not so much at the heel.
A "heel spur" at the bottom of the foot is usually not the source of pain in plantar fasciitis. A heel spur represents calcification of the muscles or plantar fascia where it inserts into the heel bone. This commonly shows up on an X-ray of the foot (whether or not there is heel pain). An asymptomatic heel spur does not require treatment.
Treatment
Treatment must consist of altering the foot support system. This can include getting better shoes, taping, using prefabricated foot supports or in the more severe cases, custom-made foot supports ("orthotics") to control the motion of the foot. Night splints, physical therapy, exercises, injections and medications can also be helpful. X-rays may be necessary to rule out other diagnoses.
For more severe and unresponsive cases, casting, shock-wave therapy and surgery may be necessary. Surgery is rarely needed to resolve this problem.