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THE MORE YOU KNOW

What is Heel Pain?

Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst.

Because there are several potential causes, it is important to have heel pain properly diagnosed. Our foot and ankle physicians are able to distinguish between all the possibilities and determine the underlying source of your heel pain.

What is Plantar Fasciitis?

Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.

Causes

The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.

Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.

Symptoms

The symptoms of plantar fasciitis are:

  • Pain on the bottom of the heel
  • Pain in the arch of the foot
  • Pain that is usually worse upon arising
  • Pain that increases over a period of months

People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.

Diagnosis

To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis.

In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Plantar fasciitis

Northern virginia Foot and Ankle

Dr. Michael A. Klein & Dr. Frank J. Smith

What is a Heel Spur?

A Heel Spur Syndrome is a calcium deposit on the underside of the heel bone. On an X-ray, a heel spur protrusion can extend forward by as much as a half-inch. Without visible X-ray evidence, the condition is sometimes known as “heel spur syndrome.”
 

Although heel spurs are often painless, they can cause heel pain. They are frequently associated with plantar fasciitis, a painful inflammation of the fibrous band of connective tissue (plantar fascia) that runs along the bottom of the foot and connects the heel bone to the ball of the foot. 

Treatments for heel spurs and associated conditions include exercise, custom-made orthotics, anti-inflammatory  medications, and cortisone injections. If conservative treatments fail, surgery may be necessary.

Symptoms

Heel spurs often cause no symptoms. But heel spurs can be associated with intermittent or chronic pain — especially while walking, jogging, or running — if inflammation develops at the point of the spur formation. In general, the cause of the pain is not the heel spur itself but the soft-tissue injury associated with it.

Many people describe the pain of heel spurs and plantar fasciitis as a knife or pin sticking into the bottom of their feet when they first stand up in the morning — a pain that later turns into a dull ache. They often complain that the sharp pain returns after they stand up after sitting for a prolonged period of time.

Causes

Heel spurs occur when calcium deposits build up on the underside of the heel bone, a process that usually occurs over a period of many months. Heel spurs are often caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone. Heel spurs are especially common among athletes whose activities include large amounts of running and jumping.

Risk factors for heel spurs include:

  • Walking gait abnormalities,which place excessive stress on the heel bone, ligaments, and nerves near the heel
  • Running or jogging, especially on hard surfaces
  • Poorly fitted or badly worn shoes, especially those lacking appropriate arch support
  • Excess weight and obesity

Other risk factors associated with plantar fasciitis include:

  • Increasing age, which decreases plantar fascia flexibility and thins the heel's protective fat pad
  • Diabetes
  • Spending most of the day on one's feet
  • Frequent short bursts of physical activity
  • Having either flat feet or high arches

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