One of the most common problems seen by physicians who care for the feet involves pain in the heel. Heel or arch pain that occurs in adult patients is most commonly caused by a condition known as plantar fasciitis. In the past, this condition may have been referred to as a heel spur.
Heel pain may also be caused by other factors, such as:
- Fracture or other trauma
- Stress fracture
- Nerve entrapment
- Cyst in the heel bone
It is important to see the right specialist for heel pain. The specialist will be able to obtain the proper history, perform an exam, and order the appropriate tests to determine the cause of your heel pain.
What causes plantar fasciitis?
This problem is caused by an inflammation of the plantar fascia (a thin strong band of tissue that extends from the heel to the toes) on the bottom of the foot. Several factors contribute to plantar fasciitis. These include:
- Having a high arched foot or a flat foot
- Wearing non-supportive footwear on hard surfaces for prolonged periods of time
- Physical factors such as obesity
- Anything that may lead to overuse injury of the plantar fascia tissue
What are the symptoms of plantar fasciitis?
Symptoms usually include pain on the bottom of the heel. Sometimes the pain involves the arch of the foot. The pain is usually worse when you get up in the morning or with the initial steps after sitting for a period of time. The pain will generally decrease after a short period of walking but may return after prolonged time spent on your feet. The pain usually becomes worse over a period of months if not treated.
How is plantar fasciitis diagnosed?
Diagnosis is made after the specialist takes note of the history and course of the condition and performs a physical examination of the foot. At times if other conditions are being considered, additional diagnostic testing may be necessary. These tests may include X-rays, bone scans, ultrasound, or magnetic resonance imaging (MRI) when needed. Occasionally, bone spurs on the bottom of the heel will be noted on X-rays, but this is not usually felt to be the source of the pain.
How is plantar fasciitis treated?
Treatment of plantar fasciitis includes:
- Stretching exercises for the calf muscles
- Supportive, sturdy, well-cushioned shoe gear to protect the injured heel
- Appropriate shoe inserts, arch supports, or custom foot orthotics to provide additional protection
- Use of a night splint to prevent tightening of the tissue during rest
- Avoidance of walking barefoot
- Avoidance of sandals and flip-flops
- Massage therapy to the heel and arch
- Ice application to the site of pain
- Limitations on physical activity, such as avoiding high impact exercises or prolonged standing
- Medications such as non-steroidal anti-inflammatory agents
- Cortisone (steroid) injections
- Weight loss program
Occasionally, if none of the above solutions are effective, casting or surgery may be considered. In general, any surgery should be avoided until conservative treatments have been attempted. Heel pain can usually be treated conservatively, without surgery.
Remember that once pain has been alleviated, you may still need to continue to wear appropriate supportive shoes and do stretching exercises to prevent recurrence.
- American Academy of Orthopedic Surgeons. Heel Pain Accessed 5/9/2016.
- American College of Foot and Ankle Surgeons. Foot Health Facts: Heel Pain (Plantar Fasciitis) Accessed 5/9/2106.
- American Podiatric Medical Association. Foot Health: Heel Pain Accessed 5/9/2016.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/1/2016…#14709