The most common cause of heel pain is plantar fasciitis with or without a heel spur. In fact, most people at some point have heel pain after the age of 45 either transient or chronic. Similar to "weakness of the eyes" and the need for reading glasses after the age of 45, the plantar fascia also gets weaker and begins to "fray" or tear where it inserts into the heel.
Contrary to popular opinion, I do not advocate "stretching" the plantar fascia. The condition exists because the plantar fascia is unable to stretch. Occasionally patients will say that they did improve with stretching, but in fact they improved in spite of stretching not because of it.
Like other soft tissue injuries, plantar fasciitis is treated with tape immobilization and will resolve in about 4-6 weeks. Patients MUST avoid going barefoot as this causes "bowstringing" of the fascia and repeated re-injury. Clogs are recommended for men and a wedge she with an elevation of 1.5" "is recommended for women to support the fascia and prevent it from tearing.
Plantar fasciitis should always be treated conservatively and does not require surgery. For long term support of the fascia, orthotic devices are recommended.
Other less common causes of heel pain include:
- Achilles tendonitis
- Heel pad atrophy
- Tarsal tunnel syndrome
- Bone Cyst
- Stress Fracture
- Systemic disease (ie., ankylosing spondylitis, psoriatic arthritis, inflammatory arthritis)
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