Heel pain is one of the most common conditions seen in my clinic. The most common condition is
plantar fasciitis although conditions such as Achilles tendinitis, bursitis and nerve entrapment are also seen quite frequently. Diagnosing the specific condition depends on a careful examination and history of how and when the pain affects the patient. Plantar fasciitis is an inflammation in the large band of tissue (plantar fascia) that extends from the heel bone to the ball of the foot and into the toes. Patient suffering from this element may experience pain in the heel and in many cases extending into the arch of the foot.

This condition is usually caused by mechanical stresses in the foot. Treatments for plantar fasciitis
usually involve mild stretching exercises, rest, shoe gear modifications, orthotic devices, splints and injection therapy. While most patients respond very well to these conservative measures some patients do not and require surgery to correct the problem.

Another cause of heel pain is Achilles tendonitis. This condition is almost always an overuse condition.

Repetitive action using the Achilles tendon puts too much stress on the tendon. This leads to micro-
injuries in the tendon resulting in inflammation. The best forms of treatment for Achilles tendonitis are; immobilization in a walking boot or cast, physical therapy, orthotics and anti-inflammatories. In some cases the tendon may be severely damaged and surgery may be necessary to repair the tendon.

Bursitis is a painful condition of the heel that is most commonly located on the bottom of the heel and also the back of the heel. It is a small fluid-filled sac that protects the heel from friction. Repetitive motion and irritation from shoes may cause the bursa to become inflamed. Treatments may include rest, ice and oral anti-inflammatories. Padding and steroid injections are very effective in reducing pain and inflammation. If conservative measures do not work surgery may be necessary to provide relief.

The least common of the 4 conditions is heel pain due to nerve involvement. In this condition the patient may feel a burning or electrical type pain that radiates into the foot from the heel. Treatment for this condition usually involves orthotic therapy and steroid injection therapy. It is necessary to stop the abnormal function of the foot and relieve pressure on the nerve. If this does not help it may be necessary to perform surgery to decompress the nerve.

Because heel pain is difficult to differentiate, it is best to be evaluated and treated by a foot and ankle surgeon.