Heel Conditions

It is estimated that over half the U.S. population will suffer with some type of heel pain in their lifetime.  Although there are many causes for heel pain, the following are the most common.

Plantar Fasciitis

This condition can occur when the inherited structure of the foot fails to give adequate support, or when there is overuse or injury in the normal foot.  The largest ligament on the bottom of the foot attaches to the heel bone and extends forward near the bases of the toes.  With chronic stress on the plantar fascial ligament it becomes inflamed and painful.  Often the pain can be related to a specific injury, change in activity (such as an increase in exercise or change in job that may require more time on your feet), or a change in foot gear (new style or type or shoe, or continuing to wear broken down shoes).  If there was a specific injury the onset of pain is sudden, but more frequently the pain is gradual in onset and becomes worse with time if left untreated.  Most people have their worst pain when the first get out of bed in the morning, or when they stand up after being off their feet for a period of time.  The pain is usually worse when barefooted.  The bottom of the heel and the inside of the arch are the most likely areas affected.  There may not be any abnormal findings on an x-ray, but ultrasound often shows the ligament to be much thicker than normal.

Heel Spur Syndrome

With chronic inflammation of the Plantar Fascial ligament mentioned above, there may be calcification of the bottom of the heel bone near its attachment.  On x-ray this is seen as a Heel Spur.  The causes, onset, and symptoms may be as those described above for Plantar Fasciitis.  The presence and size of a Heel Spur may be indicative of how long there has been abnormal stress of the ligament.  In some cases the onset is so subtle that a large spur may be present before symptoms occur.  At other times the pain can be severe but no spur or a very small spur may be seen.

Haglunds Deformity – posterior heel spur, Achilles Tendonitis

Pain can also occur on the back of the heel bone.  This may be due to inflammation of the Achilles Tendon, but can involve changes in the bone itself.  Chronic irritation or inflammation of the heel where the tendon attaches can lead to calcification of the tendon or enlargement of the back of the heel bone causing pressure against the shoe.  Foot structure and heredity can play a role, but activity level and shoe gear are also important.  Pain may occur when you walk or run and raise the heel off the ground, or may occur from direct pressure to the area. Symptoms may be sudden in onset but can also come on gradually from overuse.  If calcification is present it generally builds up over several years.  The pain may begin gradually as well, and may be increased with certain activities or types of shoes/boots.  There may be redness and swelling associated with the pain.