Why Does My Heel Hurt?

I am often asked the question, “Why does my heel hurt?” In fact, heel pain is probably the most common foot complaint seen in my practice. Many times there is no history of trauma. It just hurts, and may feel like a stone bruise.

 

In the vast majority of cases, the problem is something known as “plantar fasciitis,” an overuse syndrome where the plantar fascia becomes inflamed at its attachment to the heel bone. Overuse may not mean anything more than normal walking and wear and tear.  The onset can be initiated by a change in shoes, an increase in walking or activity, or by minimal trauma.

 

Anatomically, the plantar fascia is a broad band of dense fibrous tissue that extends from the heel bone and fans out toward the toes. This fascia acts like a bow string on a bow, helping maintain the integrity of the arch.  When one steps down, the fascia tightens. Micro tears can begin to form at the heel bone attachment.  As one continues to walk, the inflammation can increase, resulting in more pain. Often times there is an associated heel spur noted on x-ray, but the spur generally is not the cause of the problem and the pain. The problem is usually the pull and stretch of the fascia. 

 

A person will commonly state that they have pain when rising in the morning or after being seated for a long period of time.  Once on their feet, the pain will usually subside some as the fascia stretches out.  Generally, there is no pain with activity early on with the condition, but as one allows the condition to persist, pain may become more constant throughout the day. 

 

There are other causes of heel pain besides Plantar Fasciitis, and it is important to rule the others out. The differential diagnosis can include:

 

• Stress fracture of the calcaneus (heel bone)

• Systemic arthritis such as Reiter’s Syndrome

• Nerve entrapment known as tarsal tunnel syndrome

• Achilles tendon insertion pain

 

Plantar fasciitis can be treated both conservatively and surgically, with more that 90 percent of cases being resolved conservatively.  Following are some of the many conservative treatment options your doctor may choose to utilize: 

 

• Nonsteroidal anti-inflammatory medication

• Over-the-counter heel lifts or orthotics

• Oral or injectable steroids

• Custom orthotic devices

• Physical therapy

• Plantar fascial night splints

• Cast or brace immobilization 

• Taping or strapping of the foot

 

When the condition is chronic and unresponsive to conservative treatment, surgical intervention may be necessary.  The procedure usually consists of a small incision and release of the fascia either through direct visualization or through an arthroscope.  Recovery time will vary, but full return to activity without pain can be expected. 

 

Newer technology such as shock wave therapy has been shown to be effective as well. The advantage here is that there is no incision and activity can be resumed within a couple of days. This treatment is usually not covered by insurance and would need to be discussed with your doctor.  

 

So, if your heel hurts when getting out of bed in the morning, there is something wrong. Seek professional care, ask questions, and make sure you are comfortable with your physician and proposed treatment plan. Soon, you’ll be back on your feet.