There are two main causes of heel pain—plantar fasciitis and heel fat pad syndrome. Today we will discuss both of those conditions and an additional less common but more serious cause of foot pain. Here at Spine West, we diagnose and treat several causes of foot and ankle pain.
The plantar fascia is a wide band of tissue that arises from the heel bone (the calcaneus) and inserts on the toes, traveling along the foot’s arch. Plantar fasciitis is a condition where there is inflammation of the plantar fascia, usually where it attaches to the heel. People with plantar fasciitis normally report a gradual onset of pain on the inside of their heel. The pain is worse first thing in the morning (the first steps out of bed) and improves with exercise. However, it can be aggravated by prolonged standing. It is usually caused by overuse. Activities that involve pointing your feet, such as dancing or running, are the most common culprits. People with flat feet or high arches are especially at risk for developing plantar fasciitis. Additionally, tight calf, hamstring, or gluteal muscles can contribute to developing this condition.
If you suspect that you have plantar fasciitis, the best way to diagnose it is with ultrasound or MRI. Treatment includes rest, ice, NSAIDs, and self-massage with a frozen water bottle. We also recommend working with a physical therapist on eccentric strengthening exercises. Additionally, some people find shoe inserts, taping, and nighttime splints helpful. Finally, corticosteroid injections, extracorporeal shock wave therapy, or surgery are available for cases that do not improve with more conservative treatment.
The next common cause of heel pain is call fad pad syndrome or fat pad contusion. We have a fat pad over our heels that acts as a shock absorber. This fat pad can become damaged from a single traumatic episode or repeated trauma to the heels. People with fat pad syndrome report more sudden onset of pain on the outside or back of their heel. This is worse with weight-bearing activities. Fat pad syndrome is best diagnosed with MRI. Treatments include rest, ice, NSAIDs, silicone heel pads with good footwear, and taping.
A less common but more serious cause of heel pain is a calcaneal (heel bone) stress fracture. This is most commonly caused by repetitive trauma to the heel, especially in the military (from marching), runners, ballet dancers, and jumpers. In this case, the heel pain comes on slowly, is worse with weight-bearing activities, and notably improves with rest. Squeezing the back of the heel can reproduce the pain. X-ray and/or MRI can be used to diagnose a calcaneal stress fracture. Treatment includes a period of absolute rest and non-weight bearing followed by a progressive rehabilitation course.
Written by Cassy Cooper, M.D.