While there can be many reasons for heel pain, we as foot and ankle surgeons categorize heel pain into four major causes: plantar fasciitis, Achilles tendonitis, bursitis and nerve pain. Diagnosing the specific issue depends on the exact location of the pain and how the pain affects the mechanical movement of the leg.
The most common cause of the heel pain is plantar fasciitis, which is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. When patients suffer from this ailment, the fascia becomes irritated and then inflamed resulting in heel pain or pain in the arch of the foot. Plantar fascia pain is a tell-tale sign there are mechanical issues going on in how the foot works. We typically treat plantar fasciitis first with non-surgical strategies, such as stretching exercises; rest; shoe pads and footwear modifications; orthotic devices; night splints and injection therapy. While most patients respond well to conservative treatments, some require surgery to correct the problem.
Achilles tendonitis, or the inflammation of the Achilles tendon, can also be a cause of heel pain. We often see this “overuse” condition in our athletic patients who play high-impact sports, such as basketball or tennis. They often have a sudden increase of repetitive activity involving the Achilles tendon, which puts too much stress on the tendon too quickly, leading to micro-injuries of the tendon. To treat Achilles tendonitis, we often immobilize the foot with a walking boot or cast; and also use physical therapy, orthotics and ice to help repair the tendon. If the tendon is severely damaged or if non-surgical treatments don’t work, surgery may be necessary.
Another cause of heel pain commonly seen is bursitis, where the “fat pad” of the heel exhibits redness and swelling from inflammation of the small fluid-filled sac inside the heel, called the bursa. The bursa, which protects the heel from friction, can become inflamed from repetitive motion or irritation from shoes. In the case of bursitis, the heel and the toes are most often affected. Treatment may include resting the foot, ice and anti-inflammatory drug therapy, padding and corticosteroid injections to reduce the inflammation and relieve pain. Surgery may be necessary if conservative methods do not provide relief.
Finally, a somewhat less common cause of heel pain is nerve pain. When the nerves are involved, it feels more like a burning or electrical pain shooting or radiating down the foot from the heel, typically toward the toes. A patient will often tell me their heel “burns.” There are medications that may help with nerve pain, but in this instance, the patient tends to need nerve decompression surgery, a procedure to help “un-trap” the nerve causing the pain. These patients tend to have several misdiagnoses before they visit with a foot and ankle surgeon to correctly remedy their pain.
Whatever your heel pain, I always encourage people to see a foot and ankle surgeon for a proper diagnosis. We specialize in only the foot and ankle and our training helps us effectively get to the bottom of what is ailing our patients.
Dr. Michael Ambroziak, DPM, FACFAS, a foot and ankle surgeon with offices in Bay City and West Branch, Michigan, has been in private practice since 1996. He is board-certified in foot surgery by the American Board of Foot and Ankle Surgery. Dr. Ambroziak is a Fellow Member of the American College of Foot and Ankle Surgeon and a Diplomat, American Board of Foot and Ankle Surgery. He is also a lecturer at foot and ankle surgical conferences nationwide.