is usually focused on the underside or the back of your heel. If your pain is on the underside of your heel, its likely cause
is plantar fasciitis. Pain on the back of your heel, where the Achilles tendon attaches to the heel bone, is Achilles tendinitis. Although heel pain is rarely a symptom of a serious condition, it can
interfere with your normal activities, particularly exercise.
Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel may become tender or swollen from shoes with poor support or shock absorption, running on hard
surfaces, like concrete, running too often, tightness in your calf muscle or the Achilles tendon. Sudden inward or outward turning of your heel, landing hard or awkwardly on the heel. Conditions that
may cause heel pain include when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot, swelling of the fluid-filled sac (bursa) at the
back of the heel bone under the Achilles tendon (bursitis). Bone spurs in the heel. Swelling of the thick band of tissue on the bottom of your foot (plantar fasciitis). Fracture of the heel bone that
is related to landing very hard on your heel from a fall (calcaneus fracture).
Usually worse with the first few steps in the morning or at the initial point of activity. The latter usually gets better with continued activity (squeaky hinge analogy). Walking, running, sprinting,
hill running and jumping will increase the pain. Often, the natural response is to walk on the outside of the foot - in supination - to lessen the stress on the plantar fascia - resulting in new
Your doctor will perform a physical exam and ask questions about your medical history and symptoms, such as have you had this type of heel pain before? When did your pain begin? Do you have pain upon
your first steps in the morning or after your first steps after rest? Is the pain dull and aching or sharp and stabbing? Is it worse after exercise? Is it worse when standing? Did you fall or twist
your ankle recently? Are you a runner? If so, how far and how often do you run? Do you walk or stand for long periods of time? What kind of shoes do you wear? Do you have any other symptoms? Your
doctor may order a foot x-ray. You may need to see a physical therapist to learn exercises to stretch and strengthen your foot. Your doctor may recommend a night splint to help stretch your foot.
Surgery may be recommended in some cases.
Non Surgical Treatment
Most patients get better with the help of nonsurgical treatments. Stretches for the calf muscles on the back of the lower leg take tension off the plantar fascia. A night splint can be worn while you
sleep. The night splint keeps your foot from bending downward. It places a mild stretch on the calf muscles and the plantar fascia. Some people seem to get better faster when using a night splint.
They report having less heel pain when placing the sore foot on the ground in the morning. There have been a few studies that reported no significant benefit from adding night splinting to a program
of antiinflammatory meds and stretching. Other studies report the benefits of short-term casting to unload the heel, immobilize the plantar fascia, and reduce repetitive microtrauma. Supporting the
arch with a well fitted arch support, or orthotic, may also help reduce pressure on the plantar fascia. Placing a special type of insert into the shoe, called a heel cup, can reduce the pressure on
the sore area. Wearing a silicone heel pad adds cushion to a heel that has lost some of the fat pad through degeneration. Shock wave therapy is a newer form of nonsurgical treatment. It uses a
machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It's
possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells causes an increase in blood flow to
the area. Recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function.
If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles
and joints or a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely
affecting their career. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your
plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as open surgery, where the section of the plantar fascia is released by making a
cut into your heel or endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia.
Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A
disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open
surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery,
plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and
disadvantages of both techniques with your surgical team.
Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising. Wear comfortable, properly fitting
shoes with good arch support and cushioning. Make sure there is enough room for your toes.