According to the American Academy of Orthopaedic Surgeons, heel pain is the most common foot pain. Pain on the bottom of the heel can be extremely debilitating but will usually respond with conservative treatments and rarely requires surgery. The pain is often a result of a change in activities, an increase in training or inappropriate footwear.
Plantar Fasciitis
According to the AAOS, plantar fasciitis is the leading cause of pain in the bottom of the heel. The plantar fascia is a strong band of tissue that runs from the bottom of the heel to the base of the toes, giving the foot support and structure. Tight calf muscles and high arches predispose individuals to plantar fasciitis, especially those who are involved in high-impact activities. The telltale sign of plantar fasciitis is extreme pain for the first few steps in the morning. Plantar fasciitis is generally treated conservatively with ice, night splints, cortisone injections, stretching exercises and shoe inserts.
Heel Spur
According to the AAOS, one out of 10 people have heels spurs, but only one out of 20 people with heel spurs have heel pain. As a result, the presence of a heel spur is not considered a definitive cause of heel pain. Heel spurs are a calcium outgrowth on the bottom of the heel bone, formed as a result of repetitive stress placed upon the area. When conservative treatment for heel pain proves ineffective and a large heel spur exists, a surgeon may remove the spur and release the involved tight tissues in the bottom of the foot.
Heel Pad Disorder
The heel pad is a layer of fat that acts as a hydraulic absorption system, according to the American Academy of Family Physicians. In elderly or obese patients, the fat pad can hypertrophy, or thin, leaving less of a shock-absorbing layer behind. Pain caused by a heel pad disorder involves most of the weight-bearing portion of the heel and generally occurs when standing. It does not radiate down the foot and is not made worse by stretching the toes, in contrast to plantar fasciitis. Heel pad disorders are treated by methods to increase the cushioning of the foot, such as over-the-counter shoe inserts.
