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Alternative NamesPain - heel
Causes Return to top
Most frequently heel pain is not the result of any single injury, such as a fall or twist, but rather the result of repetitive or excessive heel pounding.
Plantar fasciitis is inflammation of the thick connective tissue on the sole of your foot that attaches to your heel. The pain is usually felt at the bottom of your heel and is often worse in the morning because of stiffness that occurs overnight. The following increase your risk of developing this painful problem:
Bone spurs in the heel can accompany plantar fasciitis, but are generally not the source of the pain. If you treat the plantar fasciitis appropriately, the bone spur is likely to no longer bother you.
Heel bursitis (inflammation of the back of the heel) can be caused by landing hard or awkwardly on the heel, or by pressure from shoes.
Achilles tendinitis is inflammation of the large tendon that connects your calf muscle to your heel. This can be caused by:
Home Care Return to top
When to Contact a Medical Professional Return to top
What to Expect at Your Office Visit Return to top
Your doctor will take your medical history and perform a physical examination, including a full exam of your feet and legs.
To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:
Diagnostic tests that may be performed include a foot x-ray, focusing on the heel.
If either plantar fasciitis or bursitis is diagnosed and if shoe changes and the use of orthotics have not been successful, cortisone injections may be tried. Surgery is a last resort and is seldom necessary.
If Achilles tendinitis is diagnosed, anti-inflammatory medicine may be prescribed. Heel lifts may be used. Stretching can be helpful. In particularly unresponsive cases, a walking cast or boot may be helpful. Surgery is usually not necessary.
Prevention Return to top
To prevent plantar fasciitis and Achilles tendinitis, maintain flexible and strong muscles in your calves, ankles, and feet. Always stretch and warm-up prior to athletic activities.
Wear comfortable, properly fitting shoes with good arch support and cushioning. If you pronate, look for athletic shoes with an antipronation device. If orthotics are prescribed by your provider, wear them in all of your shoes, not just while exercising.
References Return to top
Schroeder BM. American College of Foot and Ankle Surgeons: Diagnosis and treatment of heel pain. Am Fam Physician. 2002; 65(8): 1686, 1688.
American College of Radiology (ACR), Expert Panel on Musculoskeletal Imaging. Chronic foot pain. Reston, VA: American College of Radiology; 2002.
Donley BG, Moore T, Sferra J, Gozdanovic J, Smith R. The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study. Foot Ankle Int. 2007;28:20-23.
Aldridge T. Diagnosing heel pain in adults. Am Fam Physician. 2004;70:332-338.
Ho K, Abu-Laban RB. Ankle and foot. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier;2006:chap 55.Update Date: 3/4/2009 Updated by: Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.