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Heel pain – Heel spurs – Plantar fasciitis

By far, the most common cause of heel pain is plantar fasciitis – or inflammation of the plantar fascia, a wide swath of connective tissue running from heel to toes along the bottom of the foot. Repeated stress on the heel typically leads to micro-tears in the plantar fascia where it connects to the heel bone, resulting in inflammation and pain. As all sufferers of heel pain know, pain is usually worst when arising in the morning; a good half hour of hobbling about may be needed before it abates. Overnight the fascia tightens because it is not being used. Inflammation sets in and when you take that first step you are forcing a tight fascia to stretch to its maximum. Pain often recurs after extended periods of standing, walking or running.

Some people are told they have heel spurs, or you may feel like a sharp piece of bone is jutting into the heel. If an x-ray were taken of the heel, some people with heel pain would have heel spurs and some people who don’t have heel pain would have heel spurs. There is usually very poor correlation between heel pain and heel spurs. The spur, if it exists, is usually the result of the inflamed plantar fascia (the true cause of the pain) pulling on the heel bone.

Very rarely, heel pain can be caused by an arthritic or systemic medical problem. If the heel is hot, red and swollen or you have other joints that are hot, red or swollen, or you have other symptoms in your body associated with the heel pain, you should see your podiatrist or general practitioner to rule out these other causes.

A condition called tarsal tunnel syndrome can cause heel pain, but it is rare. The symptoms would likely include pain at the inside of the ankle and symptoms of numbness, tingling or burning into the bottom of the foot. Treatment is similar to that for plantar fasciitis.

Pain at the back of the heel is not plantar fasciitis. It is most likely Achilles tendonitis or may be a condition called Haglund’s Deformity, which is a bony bump that gets inflamed by chronic rubbing from shoes. These conditions are treated differently from plantar fasciitis. An accurate diagnosis by a podiatrist or other medical practitioner is essential.

The longer the symptoms go untreated, the longer it generally takes to alleviate the condition. Expect it to take 6 months to heal if you’ve gone untreated (or improperly treated) for 6 months.

Scenario
A podiatrist sees plantar fasciitis more often than any other foot complaint. Here are some typical scenarios where plantar fasciitis may occur: A 25 to 50-year-old person of normal or greater than normal weight does one or some of the following:
• Lets running shoes wear out
• Goes for an extra long walk or run (in some type of shoe they normally don’t walk or run in)
• Goes on a hiking trip (to Europe)
• Works long hours either standing or walking.
• Is under some level of increased stress (emotional, mental and/or physical)
• Has changed their walking pattern (gait) because of pain somewhere else in the body.

The longer the symptoms go untreated, the longer it generally takes to alleviate the condition. If you have been having a series of lower extremity symptoms, start thinking about the possibility that an underlying biomechanical problem is trying to get your attention.

Not everyone with plantar fasciitis has a pronation problem (collapsing arches) though many do; not everyone with a pronation problem will get plantar fasciitis, but they will likely have some pronation-related problems (plantar fasciitis, bunions, neuromas, knee pain, tendonitis, low back pain).