The most prevalent foot complaint presented to a foot specialist (podiatrist) is heel pain syndrome. Invariably, the patient has tried a multitude of over-the-counter products, such as Tylenol (acetaminophen) or aspirin, heel cups, arch supports, new shoes, foot soaks, reflexology, foam pads, and ice packs. The patient has typically endured this pain from 2 months to 2 years prior to seeking professional intervention.

There are many causes (etiologies) of heel pain. In fact, the most common cause of heel pain is not the heel spur, but a ruptured tissue called the plantar (sole) fascia, which results in the condition of plantar fasciitis. Plantar fasciitis presents early ambulatory pain, usually when arising in the morning, or upon rising and bearing weight after rest. The discomfort lasts approximately 10 to 15 steps then ceases only to return later in the day.

The heel spur may present its pain on the bottom or the back of the heel bone (calcaneus). This cause of heel pain is constant and hurts equally with each step. It can also be excited with stretching of the heel cord. X-rays help to confirm this entity, yet many x-rays reveal heel spurs despite the fact that the patient has no heel pain. Therefore, do not assume heel pain is caused by heel spurs.

Another emerging complaint of heel pain is caused by Tarsal Tunnel Syndrome (TTS). In this condition, the tibial nerve is entrapped and irritated by connective tissue that strangulates the nerve. This condition produces electrical sensations, shooting discomfort, and/or numbness. The pain may change its characteristics but will increase with activity.

Although the heel is not a joint, it can fall victim to joint disorders. Such examples are gout, Rheumatoid Arthritis, Rieter’s Syndrome, and Lupus. These can cause focal attacks with a great amount of inflammation and may also vary in presentation. Laboratory analysis sometimes helps to confirm this problem.

A tumorous mass of soft tissue or bone is not to be excluded when considering the cause of heel pain. X-rays and cat scans commonly reveal bone tumors or cysts, where as MRIs reveal soft tissue tumors. These can be benign or malignant (rare). Of course, true definition of a tumor is by excisional biopsy of the mass, which could also be the treatment in itself.

Trauma can lead to a fracture of the bony tissue of the heel (calcaneal fracture). Generally, a blunt force can cause a recognizable fracture, whereas repetitive activity can cause an occult hairline (or micro) fracture, which is both difficult to treat and hard to identify on an x-ray.

Metabolic processes such as high blood pressure, high cholesterol, osteoporosis, Diabetes Mellitus, Paget’s Disease, and idiopathic skeletal hyperostosis can create heel pain. These conditions lead to obesity, which will commonly prolong or devoid the treatments to help heel pain.

Just as there are many causes of heel pain, there are many treatments, recommendations, and modalities. The goal for the podiatric physician is finding the appropriate treatment for each patient. These may include nonsteroidal anti-inflammatory drugs (NSAIDS), oral and injectable steroids, custom made arch devices (orthotics), night splints, and heel cups. Physical therapy modalities such as whirlpool, ultrasound, and stretching exercises may also be employed. Should these fail to relieve the condition, then surgery may be warranted.

Dr. Graham has been in private practice in Effingham since 1989 and is on staff at St. Anthony's Memorial Hospital and Effingham Ambulatory Surgical Treatment Center. He is Board Certified by the American Board of Podiatric Surgery and American Board of Podiatric Orthopaedics and Primary Podiatric Medicine. Dr. Graham is a Fellow of the American College of Foot and Ankle Surgeons, the American College of Foot and Ankle Orthopaedics and Medicine, and American Professional Wound Care Association. He is also a member of the American Podiatric Medical Association and the Illinois Podiatric Medical Association.

Return to top
Return to articles