by Kate Moyer

Created on: February 15, 2009

One of the most common ailments affecting the feet is heel pain. Heel pain can have a variety of causes including bursitis or less commonly, a stress fracture of the heel bone. By far, the main cause of heel pain is a condition known as plantar fasciitis. The plantar fascia is a long band of connective tissue that stretches from the heel bone to the ball of the foot. The area where the fascia attaches to the heel bone becomes inflamed, usually due to stress from faulty functioning of the foot during the walking cycle. Plantar fasciitis is difficult to ignore because every step hurts. Usually the pain is worse after rest, especially with those first steps in the morning.

A visit to the Podiatrist's office for heel pain will likely include an evaluation of your foot structure and function to identify any tight tendons or abnormalities that may be the source of the pain. An x-ray may be taken to identify bone abnormalities such as spurs or stress fractures. Seeing spurs on the heel bone may indicate chronic inflammation or tightness where ligaments attach to the bone.

To treat the pain and help decrease the inflammation of plantar fasciitis, a podiatrist may recommend a cortisone injection to the heel or anti-inflammatory medication. Activities to be done at home such as wearing supportive shoes, stretching exercises, and applying ice to the heel may be recommended. Physical therapy may be warranted to help loosen up tight tendons and ligaments. An important part of the treatment is the use of foot orthotics, or arch supports to help balance the feet and take stress off the plantar fascia.

Foot
orthotics come in over-the-counter varieties, which are fit by a person's shoe size or are custom-made. With custom-made orthotics, an impression or digital scan is performed on a patient's feet and the actual orthotics are made by a laboratory. While these are more expensive than over-the-counter orthotics, they have the advantage of fitting a person's foot more accurately and often stay durable for many years.

According to the American Podiatric Medical Association, 90% of heel pain patients respond to initial therapies within a relatively short period of time. Sometimes other potential cause of the heel pain need to be investigated. Less likely causes such as a nerve entrapment in the heel area or medical conditions such as certain types of arthritis may have to be ruled out. If these treatments do not take away the pain and other potential causes of the pain have been ruled-out, the podiatrist may recommend treatments such as surgery or minimally invasive procedures such as ESWT, or Extra-Corporeal Shock Wave Therapy. When the pain subsides, it is best to keep using
orthotics and supportive shoes and to stretch on a daily basis to help prevent recurrence.

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