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Heel pain and heel spurs

What causes painful heels?

Heel pain is most commonly caused by plantar fasciitis, an inflammatory condition of the thick band of tissue on the sole of the foot, which is known as the plantar fascia.

Symptoms

The heel pain of plantar fasciitis is often worst during the first few steps in the morning and can increase with standing or after exercising.

What causes plantar fasciitis?

Biomechanical abnormalities that cause the foot to abnormally pronate (roll in) on walking are the cause of most cases of plantar fasciitis. Sometimes painful outgrowths of bone called heel spurs (see below) can form where the plantar fascia joins the heel bone; however, these are not the main source of the heel pain.

Treatment

Treatment for plantar fasciitis may include rest, stretching, applying ice, anti-inflammatory medicines and weight loss to reduce stresses on the feet. If necessary, foot supports, strapping or orthotics may be recommended to correct structural abnormalities of the foot.

Heel spurs

Pain in the heel area is very common and it may be associated with a calcaneal spur, sometimes called a heel spur.

Our feet are made up of a series of small bones, known as the tarsal bones. The calcaneus is one of the largest and makes up the rear, or heel, of the foot. A strong band of sinew (the plantar fascia) stretches across the sole of the foot below the surface of the skin and is attached to a point in the middle of the undersurface of the calcaneus.

With repeated activity on our feet, this fascia causes persistent traction (tugging) on the attachment point into the bone, and inflammation and pain can develop at this site. This painful condition is known as plantar fasciitis (see above).

Sometimes, a sharp 'spur' develops at the site of this traction on the bone and protrudes into the surrounding tissue. But the pain is usually due to the plantar fasciitis, rather than the heel spur itself.

Plantar fasciitis has also been known as 'policeman's heel', although this term is not often used, perhaps because police officers do not 'walk the beat' as much as they used to.

Treatment usually involves padding or shoe inserts to take pressure off the tender area. It may help to avoid activities that aggravate pain, such as long walks and running. Paracetamol or anti-inflammatory medicines may also be used to relieve pain (ask your pharmacist for individual advice as anti-inflammatories are not suitable for everyone). Sometimes injections or, very rarely, surgery will help.

Original material provided by myDr, 2008. Edited by everybody, January 2012.

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