Heel Pain

heel-painPlantar fasciitis (heel pain) is commonly traced to an inflammation on the bottom of the foot. It is caused by inflammation of the connective tissue that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone.

What does heel pain feel like?

It feels like a dull ache most of the time, but when the patient first gets out of the bed in the morning, or when getting up after sitting for a period of time during the day, the pain in the heel is impressive. It almost feels like the heel has been bruised, like falling on a rock barefoot, but it is worse.

What caused the heel pain?

There is a tight ligament (band of fibrous tissue) that stretches across the arch, from the ball of the foot to the heel bone, called the plantar fascia. When we walk, our feet have a tendency to roll inward, toward each other, in a motion that we call pronation. When feet pronate, they flatten and stretch out, and the arch elongates. This causes excessive pulling on the plantar fascia ligament and attachment of the ligament to the heel bone begins to separate. An injury occurs where the ligament progressively tears off the heel, fiber by fiber. Bleeding occurs next to the bone and inflammatory fluids accumulate between the ligament and the bone, forming a bursitis, or swollen and painful fluid-filled sack.

Over time, the body lays down scar tissue, in an attempt to “glue” the detached ligament fibers back on to the bottom of the heel bone. Over the course of 3-5 years, the scar tissue calcifies, and this calcium deposit eventually becomes visible on X-ray as a heel spur. This inflammation of this plantar fascia ligament is called plantar fasciitis, and in addition to the bursitis, is what causes the pain.

How did this happen?

There are several reasons that this chronic injury can occur. Recent weight gain and increased activity level often start an episode. A person who has been mostly sedentary, then walks a lot at Disney World for 3 days, is a prime candidate. A change of shoes from well supporting walking or athletic shoes to floppy sandals can do it, too. When the arch of the foot collapses or flattens, the plantar fascia stretches, causing the injury where it attaches to the heel bone. Finally, conditions which cause generalized increased inflammation, like osteoarthritis or rheumatoid arthritis, can contribute.

Treating heel pain

There are many treatment options available for heel pain. In most cases conservative treatment is all that’s needed or recommended. Treatment such as heel pain stretches, orthotics, physical therapy, proper shoes or painless laser therapy may be enough to treat your heel pain. If you have a severe case, surgical intervention may be required.

Preventing heel pain

Recurrence is rare after treatment, if the patient continues to employ good mechanical foot control by continuing to wear orthotics and good supportive walking or athletic shoes. Recovery is rapid and the success rate is better than 90%.

Why do I have heel pain in the morning?

Heel pain in the morning is very common with plantar fasciitis. The pain is more intense in the morning because your foot has been resting for an extended period of time and you wake up and put all of your weight on the foot. Over the night, the muscles, ligaments and tendons in your foot have become tight and rigid. Once you apply pressure by standing up, you are stretching them more than they can handle from being so inflexible.

Usually, the first steps out of bed are the worst and the pain slowly fades as you walk around. This is because you are allowing your foot to warm up and stretch out. The foot will become more flexible as you walk.

Heel spurs may also cause morning heel pain. A heel spur is when a part of the heel bone grows out of the area causing the bone to stab into the tendons and ligaments in the heel. The pain is more intense in the morning because of the excess weight put on the foot after resting for a longer periods of time.

Treatment for morning heel pain includes:

1. Heel stretches

2. Orthotics

3. Never walking barefoot (give your feet extra support)

4. Injections