Surveys have reported that one in five Americans suffers from heel pain. There are many possible causes of heel pain. Generally this type of pain is the result of faulty biomechanics (abnormal walking) which places too much stress on the heel and the surrounding tissues. The stress on this part of the foot may also be the result of injury, or a bruise incurred while walking, running, or jumping on a hard surface; wearing poorly constructed shoes; 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 stresses that can affect its integrity and its ability to keep us on our feet. Heel pain can be disabiling and may 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, forepart of the heel bone. The spur, visible on x-ray appears as a protrusion that can extend forward as much as half,an inch. When no bone enlargement is seen this condition is often referred to as heel spur syndrome.

Heel spurs result from strain on the muscles of the foot, by stretching the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. Both heel pain and heel spurs are often associated with an inflammation of the fibrous connective tissue(fascia) that runs along the bottom(plantar surface) of the foot, from the heel to the ball of the foot. This particular type of inflammation is called plantar fasciitis. It is common among athletes who run and jump alot, but is also seen in the general population.

The condition occurs when the plantar fascia flattens out and elongates over time beyond its normal extension, causing the soft tissue or the fascia to tear or stretch at various points along its length, including at the heel bone. A gap may occur between the heel bone and the fascia which fills in with new bone(spur).

The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the constant irritation that is brought on by certain athletic activities. Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest.

Treatment for plantar fasciitis or heel spur syndrome involves three key activities; heat, stretching and support. Initially reducing the inflammation is the most important component since it enables the other activities to be started. Oral or injectable medication may be used to control the inflammation, in addition to reducing the pull of the plantar fascia. Supporting the arch involves the use of appropriate shoes, over the counter supports and prescription orthotic devices. If conservative methods do not relieve pain surgery may be necessary.

Podiatrists report that a new approach to heel spur surgery reduces the risk of complications and scaring, is up to 90 percent more effective than other procedures and allows for a faster recovery time. In the study, 14 patients complaining of sharp pain in the heel underwent the new transverse incisional approach for the treatment of heel spurs. The new surgical procedure involves an incision on the bottom of the heel just before the arch. The difference in this procedure versus other techniques is that no splint or cast is needed. A custom-made foot orthotic device may be needed to provide support post operatively. Although a small number of patients participated in the study doctors of podiatric medicine are encouraged by the results.

For a free heel pain brochure or other information visit the American Podiatric Medical Assoc. website at www.apma.org.

Dr. Ravick is past president of the DC Podiatric Medical Association, a spokesperson for the American Podiatric Medical Association, in private practice at Capital Podiatry Associates since 1980 and often quoted in national and local media.

Founded in 1912, the American Podiatric Medical Association is the nation’s leading professional society for foot and ankle specialists, with membership of over 10,000 doctors of podiatric medicine. Visit APMA or call 1-800-FOOTCARE.