The most common cause of
deep pain on the bottom surface of the heel, is plantar
fasciitis (inflammation of the plantar fascia). The
plantar fascia is a broad
band of fibrous tissue which runs along the bottom surface of the
foot, from the heel to the toes. It is just below the skin and subcutaneous
fat. It helps to secure the arch. Long standing inflammation causes
the deposition of calcium at the point where the inserts into the
heel bone. This results in the appearance of a bony heel spur
on x-ray. The spur itself is not the source of the pain. Stubborn
heel pain should be evaluated by your podiatrist.
- Sharp pain localized to the bottom and/or
inside margin of the heel.
- Often worse on arising in the morning
and after rest.
- Aggravated by prolonged weight bearing
- May severely limit activities.
- Most common in middle-aged and overweight
- Excessive load on the foot from obesity.
- Excessive flattening of the arch on weight
- Tight plantar fascia.
- Over pronation of the foot (a
complex motion including outward rotation of the heel and inward
rotation of the ankle).
What you can do
- Application of ice to the heel area after
- Wear supportive shoes with a stiff heal
counter (the part of the shoe which wraps around the heel) and a
good arch. A well made running or walking shoe is a good example.
- Sometimes a shoe with a moderately high
heel will relieve pressure on the fascia.
- Stretching exercises for the calf muscles
will also help stretch the plantar fascia. This should not be attempted
when the heel is sore.
- Over the Counter anti-inflammatory medications
containing ibuprofen or aspirin when tolerated.
What the doctor may do
- Prescription doses of anti-inflammatory
- Inject powerful anti-inflammatory medication
to calm inflammation around the painful area.
- Apply taping and
padding to relieve strain on the plantar fascia
- Administer physical therapy (eg. ultrasound,
- Control foot function with an orthotic
- Prescribe special splints to help stretch
- Surgical release of the plantar fascia
and excision of the heel spur (rarely required).
Other causes of heel pain
- Various types of arthritis
- Trauma to the heel
- Inflammation of the tendons around the
- Heel Neuroma (benign tumors of the nerves
around the heel)
- Abnormality in the shape of the heel bone
- Foreign body in the heel (eg. splinter)
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