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Because there are several potential causes of heel pain, it is important to have heel pain properly diagnosed. A podiatric foot and ankle surgeon is best trained to distinguish between all the possibilities.

Heel pain can be caused by stress fractures, tendonitis, arthritis, nerve irritation, or, rarely, a cyst. But, by far, the most common cause of heel pain is plantar fasciitis.

Plantar fasciitis, the most common cause of heel pain, is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. It is also called heel spur syndrome when a spur is present. Heel pain results when the fascia becomes irritated and then inflamed. The typical symptom is pain on the bottom of the heel that is usually worse upon arising and that increases over a period of months. People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they've been sitting for a long period. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people, the pain returns after spending long periods of time on their feet.

The most common cause of plantar fasciitis is a structural abnormality in the foot. People who have problems with their arches - either overly flat or very high-arched feet- are more prone to developing it. Wearing shoes without proper support on hard surfaces can also put strain on the fascia, leading to fasciitis. Obesity can contribute, as well.

Diagnosis of the cause of your heel pain is performed by your podiatrist. Physical examination of the foot is the first step. Then, if necessary, x-rays, diagnostic ultrasound, bone scans, or magnetic resonance imaging (MRI) may be used to give a complete picture. Sometimes, heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain.

There are several levels of treatment used when dealing with plantar fasciitis. The first level is simple changes that the patient can begin at home: calf-stretching exercises that help ease pain, avoidance of going barefoot, application of ice packs to the heel for 10 minutes several times a day, a change to more supportive shoes, weight loss, and the use of non-steroidal anti-inflammatory drugs such as ibuprofen.

If you still have pain after several weeks, your podiatrist may recommend additional approaches. These can include padding and/or strapping in your shoes, custom orthotic devices, walking casts, a night splint to help maintain a stretched fascia while you sleep, physical therapy, or steroid injection therapy.

Most patients with plantar fasciitis respond to one or more of the non-surgical therapies above. A small percentage of people, however, may require surgery. If your heel pain doesn't respond after several months of non-surgical treatment, your podiatric surgeon can discuss surgical options with you.