Heel pain can be due to a variety of conditions. Doctors can usually diagnose the cause of heel pain by taking a careful history and examination. Sometimes, it may be difficult to differentiate the causes of heel pains and tests such as electromyography, X-rays and bone scans. Many causes of heel pain are treated symptomatically with pain-control measures and by the use of proper footwear. In some patients with pain that does not respond to these measures, surgery may be necessary.
Plantar Fasciitis
Plantar fasciitis produces a pain that patients describe as "nerve pain." The plantar fascia is a band of fibrous tissue beneath the skin on the sole of the foot. It is important in forming the arches that are characteristic of human feet. In individuals with foot arch problems, sudden weight gain, and who wear poorly fitting shoes the plantar fascia can become inflamed. Plantar fasciitis may also occur in long-distance runners, and especially those who run downhill or on uneven surfaces.
Symptoms
Plantar fasciitis causes a pain in the heel, which may be dull and aching in nature or may be severe. Some affected individuals describe the pain as sharp and stabbing in nature. The pain is worse in the early hours of the morning and with the first few steps an individual takes every morning. It can also be aggravated by climbing up steps and following intense activity.
Treatment
The pain can be relieved somewhat by stretching, over-the-counter analgesics and by the use of proper footwear. Ice can also help to reduce the pain, and doctors recommend using splits and and shoe supports. If these measures fail, steroid injections and possibly surgery may be needed.
Tarsal Tunnel
The nerve of the heel is the posterior tibial nerve. On its way to the foot, it passes through a fibrous encasement, called the "tarsal tunnel." The nerve can become trapped in this tunnel, causing pain. This can be considered the leg's version of the well-known carpal tunnel syndrome. This heel pain, which is truly a nerve pain, can cause burning, numbness and tingling. The pain and numbness can also spread up to the toes. The condition can be treated with analgesics and surgery to enlarge the tarsal tunnel.
Other Causes of Heel Pain
A neuroma is a small tumor of a nerve; sometimes one of the nerves of the heel can develop this small tumor and cause symptoms similar to plantar fasciitis. Other causes of heel pain include osteomyelitis, an infection of the bone, bursitis and a variety of autoimmune disorders. The tendons that pass from the leg to the foot can also become inflamed; this condition is called "tendonitis."
