Heel pain can have many different types of causes. It is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress and strain on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed foot wear; or being overweight.
The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back or bottom of the heel.
A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication on bone enlargement the condition is sometimes referred to as “heel spur syndrome.”
Heel spurs result from a strain on the muscles and ligaments of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.
Heel pain can also include symptoms from systemic diseases such as rheumatoid arthritis. Still other things like bursitis, neuroma (soft tissue swelling of a nerve), Achilles Tendonitis, bone bruises, and stress fractures to name a few.
Children and Heel Pain: children can be affected with heel pain like adults can. It most commonly occurs between the ages of 8 and 13 as they become increasingly active in sports activity in and out of school. There are growth centers at the back of the heels that can become inflamed. Activity like jumping can irritate the growth centers and cause an inflammatory reaction. This can be treated by decreasing the activity, placing the child in a walking boot and adding anti-inflammatory drugs if needed. Once the growth plate matures into regular bone, this particular type of heel pain resolves.
Plantar fasciitis is one of the most diagnosed conditions in podiatric medicine. This is a heel pain that is present after periods of rest. The pain will be typically located at the back of your arch, on the inside of the foot (that is the same side of the foot that the big toe is on), near the start of your heel. You will feel this primarily first thing in the morning when you jump out of bed. Typical symptoms feel like a stone bruise. It is inflamed and painful for a little while then calms down as you “work it out” and get moving and stretching the foot for the day. You may also experience this painful sensation after shorter periods of rest like watching tv, watching a movie, sitting at the computer for a while, stepping out of your car after driving, etc…
There is no one single cause that starts this inflammatory reaction. You could have a gain in weight, loss of weight, change in activity, starting of an exercise program, use of treadmills, poor fitting shoes, trauma to the area and so on.
The most important thing to realize is that this bone bruise feeling will not go away on its own with out treatment. Since inflammation is the root cause of your pain, I will primarily treat the inflammation with several different modalities.
Severe cases of plantar fasciitis may require custom molded orthotics. Still other case may require surgery to address the inflamed area of your heel. I always start with more conservative care then if really needed suggest surgery.