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Pain in the heel is one of the most common complaints that a foot specialist hears. The cause of heel pain is one of the most controversial subjects in the specialty. With treatment, however, most patients can be relieved of their symptoms.

The condition

The pain is typically worse in the morning and with walking but tends to get better through the day. Individuals with flat feet and tight heel cords are frequently affected, as are those who are overweight or overdo athletics.

A heel spur is seen on X-ray in only about half the cases of heel pain. It forms at the attachment of muscle to the heel. Heel spurs are not the cause of pain. Many heel spurs are not painful at all.

The cause

The most common cause of heel pain is the pull of the heel exerted by the muscles and ligaments that support the arch of the foot, an overuse condition similar to bursitis of the shoulder or tennis elbow.

Other causes of heel pain include: nerve entrapment, stress fracture of the heel bone, inflammatory diseases (such as rheumatism or gout) or a bruise of the fat pad under the heel.


Treatment is tailored to the cause of the heel pain. Heel pain, even without treatment will usually subside, but may take a long time. 90-95% of patients with plantar heel pain will be cured with non-operative treatment. The treatment is done in stages, according to the duration of the problem and the degree of the pain.

Stage 1

Achilles tendon stretching

Weight reduction

Night splint

Ice massage and rest

Shoes with good arch support and cushioned soles

Heel cups to raise the heel and relieve the strain on the plantar fascia

Anti-inflammatory drugs to reduce irritation and pain. (These drugs can be irritating to the stomach and should always be taken with food)

Stage 2

If the problem continues, the tender area can be injected with hydrocortisone and a local anaesthetic.

Stage 3

For the difficult, chronic problem, a cast can be tried. Either a removable type such as a slipper cast, a cast brace, or a standard walking cast.

Stage 4

Surgery can be done if the other treatments fail. The aim is to release tight ligaments, relieve nerve pressure, or do both.

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