Heel Pain - Ouch!!! by Dr. Tom Reed

Heel pain is one of the most common problems seen in our office. Patients usually complain of pain in the heel when getting out of bed in the morning, pain when getting up to stand after a short time sitting, or pain in the arch and heel when walking. The condition is know as plantar fasciitis. There also may be a heel spur seen on x-ray, but the spur is NOT the cause of the problem. It is the plantar fascia which is a long band, kind of like a tendon, which stretches from the heel to the ball of the foot. It is very similar to a bow string which has become overstretched and weak and has small tears in it which causes pain and inflammation.

Most people who have plantar fasciitis are overweight, or have flat feet, or are on their feet for long periods of time. These conditions put a lot of stress on the plantar fascia and pain results. The treatment is usually conservative to start with. This works in about 80% of the cases. After we get people well with conservative care, we usually recommend long term control of the symptoms with orthotics. which are custom made inserts that help support the arch and take the strain off the heel.

Sometimes surgery is necessary. It is quick and very successful and a lot of times we can use an endoscopic procedure where we use small incisions and a camera to correct the problem. In most cases, patients walk on the foot after the surgery. But we do like to try conservative care first if possible.

There are other causes of heel pain that are not as common. Sometimes, there is a spur on the back of the heel which has formed over the years. It irritates the back of the heel, especially in shoes. This is a surgical problem and the spur needs to be removed. Also, sometimes there can be pain on the inside of the ankle that can radiate to the bottom of the heel. This is called Tarsal Tunnel Syndrome. It is very similar to Carpal Tunnel Syndrome in the hand. A very simple surgical procedure is performed to correct the problem.