Heel pain is probably the most common complaint in a podiatry office. The characteristic comments I hear when someone presents to my office is that the pain is quite significant in the morning or after periods of rest. The pain tends to “warm-up” as the person begins walking. The pain has usually begun after a significant hike or long vacation where a lot of walking had been done.

Patients usually complain of a “heel spur”. However, although there may be a heel spur, this is usually not the source of pain. Rather, it is the plantar fascia that you can strum on the arch of your foot. It is connected to you heel bone where it can partially tear away from and cause painful inflammation. So, like a truss bridge, the plantar fascia ligament is under tension as you step down on your foot. If the fascia were to rupture than your arch would partially fall (there are other structures supporting your arch in there as well). Therefore, supporting your arch with a structure, ie. an Orthotic, will alleviate tension on the plantar fascia and allow it to heel.

Of course this condition is inflammatory and therefore anti inflammatory medications(NSAID’s) are very helpful in reducing pain initially. Examples would be Advil (ibuprofen), Aleve (naproxen), and Celebrex (celecoxib). Ice, however, is one of the best anti inflammatories if it is used. The problem is time. I tell my patients that if they use ice on the area of pain for 20 minutes, 3-5 times a day, than they will see significant relief of pain over the next 2 weeks. (make sure to remove the ice for a minimum of 20 minutes between each application to avoid cold injury)

Injection of Steroid and anesthetic can also be performed and will provide immediate relief for an unknown amount of time. I usually see about 1 week of relief followed by a return of about 50% of the pain. A second injection will typically get another 3-5 weeks and further reduction in overall pain. If this is combined with orthotics, pain is usually gone in about 6 weeks.
A small percentage of unfortunate people will continue to have pain despite best efforts and may require Shock Wave Therapy(ESWT) or even surgery.