is usually focused on the underside or the back of your heel. If your pain is on the
underside of your heel, its likely cause is plantar fasciitis. Pain on the back of your heel, where the Achilles tendon attaches to the heel bone, is Achilles tendinitis. Although heel pain is rarely
a symptom of a serious condition, it can interfere with your normal activities, particularly exercise.
some heel pain can be caused by rheumatological diseases, and these pains can do a real good impersonation of plantar fasciitis symptoms. Seronegative Arthropathies such as Psoriatic Arthritis,
Reactive Arthritis and Ankylosing Spondylisis are the most common types to cause heel pain by producing an inflammatory reaction where the fascia attaches to the heel. This is called an enthesitis.
If you have a history of Psoriasis or a family history of other arthritic conditions listed above we recommend you see a clinician about your heel pain to confirm the diagnosis. Another occasional
cause of heel pain is loss of the cushioning fat pad of the heel, which can result in a bruised heel bone (calcaneus). If you can easily feel your heel bone through your skin on the bottom of your
foot you may well have poor fatty tissue on your heel. Pressing on the centre of your heel should feel like pushing into firm rubber, and your skin should not move easily. If you can pinch the skin
under your heel and feel a very hard lump when you press the bottom of your heel then it is likely you have a heel fat pad problem. One simple final test is to walk on a hard floor. If you feel the
pain only when your heel hits the ground a fat pad problem is most likely. If the pain mainly occurs as you lift the heel off the ground it is more likely to be plantar fasciitis.
Plantar fasciitis is a condition of irritation to the plantar fascia, the thick ligament on the bottom of your foot. It classically causes pain and stiffness on the bottom of your heel and feels
worse in the morning with the first steps out of bed and also in the beginning of an activity after a period of rest. For instance, after driving a car, people feel pain when they first get out, or
runners will feel discomfort for the first few minutes of their run. This occurs because the plantar fascia is not well supplied by blood, which makes this condition slow in healing, and a certain
amount of activity is needed to get the area to warm up. Plantar fasciitis can occur for various reasons: use of improper, non-supportive shoes; over-training in sports; lack of flexibility; weight
gain; prolonged standing; and, interestingly, prolonged bed rest.
Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You
will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot - this could
be a sign of nerve damage in your feet and legs (peripheral neuropathy), your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone
infection, you have stiffness and swelling in your heel - this could be a sign of arthritis. Possible further tests may include, blood tests, X-rays - where small doses of radiation are used to
detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.
Non Surgical Treatment
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home. Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with
recovery. Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia. Ice. Putting an ice pack on your heel for 20 minutes several times a day helps
reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin. Limit activities. Cut down on extended physical activities to give your heel a rest. Shoe
modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia. Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen, may be recommended to reduce pain and inflammation.
Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver
high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a
"numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National
Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are
uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies
found the procedure to be no better than a placebo (sham treatment).
The following steps will help prevent plantar fasciitis or help keep the condition from getting worse if you already have it. The primary treatment is rest. Cold packs application to the area for 20
minutes several times a day or after activities give some relief. Over-the-counter pain medications can help manage the pain, consult your healthcare professional. Shoes should be well cushioned,
especially in the midsole area, and should have the appropriate arch support. Some will benefit from an orthotic shoe insert, such as a rubber heel pad for cushioning. Orthotics should be used in
both shoes, even if only one foot hurts. Going barefoot or wearing slipper puts stress on your feet. Put on supportive shoes as soon as you get out of bed. Calf stretches and stretches using a towel
(place the towel under the ball of your feet and pull gently the towel toward you and hold a few seconds) several times a day, especially when first getting up in the morning. Stretching the Achilles
tendon at the back of the heel is especially important before sports, but it is helpful for nonathletes as well. Increasing your exercise levels gradually. Staying at a healthy weight. Surgery is
very rarely required.