The cause of heel pain can be from a variety of things but the most common cause is the plantar fascia is injured and is trying to heal itself.  The cause of the injury is different for everybody.  Some people can injury the ligament by gaining weight puting more stress than normal on it.  This can also happen by increasing your activity such as starting a workout program.  Shoes also can be a big factor in causing heel pain.  Sometimes the type of shoe you wear is not beneficial for the health of your foot.  Fashion should not over-rule comfort. 

Occasionally the source of pain is coming from a nerve that enters the foot on the inside of your heel.  This would be termed Tarsal Tunnel Syndrome.  It can also affect the first branch from the lateral plantar nerve called Baxters nerve as well.  This is usually identified clinically and with a special nerve test called an EMG/NCV.

Heel pain is usually related to the soft tissue and another problem is an inflammed bursae on the bottom of the heel.  This is usually in people have a thin fat pad on their heel and is usually aggrevated by long standing and poorly cushioned shoes.

 Bone structures can also cause heel pain and this includes those that have a large or broken heel spur.  Generally though the heel spur is not a pain generator and nothing needs to be done to remove them.

This list in not all inclusive but discusses the more common causes of heel pain.

Typically a visit to the doctors office for heel pain is a clincal exam as well as a pertinent history of the condition.  Make sure to tell the doctor about your symptoms including tingling, burning, numbness as well as when the pain is the worst.  Also include what things you have done to get it better.  Most people with plantar fascia will have First Step Pain.  This can occur in the morning or after sitting. 

X-rays are sometimes ordered but generally do not add much to the diagnosis more-so exclude certain things.  Sometimes X-rays are not ordered on the first visit and not ordered unless you don't respond to treatment.  This depends on the clinical findings. 

Nerve studies are performed by a neurologist at another office and usually help to rule out nerve damage or tarsal tunnel syndrome.  Again this is usually not ordered on the first visit unless the symptoms warrant such a test.

 MRI's are very useful in determining the amount of damage to the plantar fascia as well as look at other soft tissue structures that could possibly be injured.

Biomechanical and gait examination is VERY useful and can sometimes explain why things are happening to the feet or legs.  If your doctor has not seem you stand and walk, they may be missing something very important.

Inserts can be very effective at treating plantar fasciitis.  The reason they are helpful is because you are controlling the motion of the foot and preventing the plantar fascia from excessively stretching.  This often times is needed in combination with using a good pair of shoes.  Often times adding an insert into a shoe makes the shoe harder to wear, so often you are restricted to what kind of shoes you can wear.  It is worth the hassle if you can get this foot pain to go away.

Over-the-counter Inserts:

These are available at shoe stores, pharmacies and durable medical goods suppliers.  Typically these should be less than $100.  They are usually flexible so to allow for the insert to conform the shape of your foot.

Orthotics (Prescription Inserts):

Prescription inserts are made specifically to YOUR feet.  This is done by getting a computerized image both walking and standing to measure your pressure points.  From this we can fabricate an orthotic to treat a multitude of problems.

Stretching:  Stretching the calf muscle and the plantar fascia should be done frequently to help soften the scar tissue that is forming when the ligament is healing.   This stretch is performed by keeping your heel flat on the ground behind you and leaning forward.  You will feel a pull in the back of your calf.  You can also slightly bend you knee but still be sure to keep your heel on the ground.  Make sure you do a lsow even stretch and don't "bounce", otherwise you can injure your calf muscle.

Plantar Fascia Specific Stretch:  This is done when sitting down and you pull the big toe towards your ankle and also pull your foot up.  You can then massage the plantar fascia.  This has been shown to be the more effective stretch but sometimes more challenging for the patient.

Stair Stretch:  You can also stand at the edge of a stair or curb and drop your heels down below the level of the ankle joint to stretch your calf muscle out.

Stretching is an important part of the recovery process with plantar fasciitis.  The more flexible the ligament becomes the less likely it has of being re-injured.  Try to spend 10-15 minutes 3-5 times a day stretching the plantar fascia if you are having problem with heel pain.

Shoe selection is very important!  Let me restate that- Shoe selection is VERYimportant. 

Often times she shoe is the cause of the problem and a full day in a pair of bad shoes can render someone with foot pain for weeks or even months.  Shoes have a wide variety with regards to sole support, forefoot width and heel height.  In general a better supportive shoe with a slight heel height is better for patients with plantar fasciitis.  High heels and cowboy boots are generally not going to put as much tension or pull on the plantar fascia at the heel and thereby makes it feel better.  Having a sole that is stiffer will not allow the plantar fascia the stretch as much and thereby allow it to heal. 

When looking for shoes take this advice into consideration.  It is often hard to find the right blend of sole support and cushioning that is needed.  Often times it helps to add an extra insert into the shoe as well.

Injection:

Steroid injections are a good form of pain relief for the plantar fascia.  The medication is very strong and can quickly reduce the pain in the ligament.  Often times the medication takes effect immediately but can vary and take as long as 48 hours.  There are disadvantages to using steroid, particularly if you use too much.  You can get thinning of the fat pad and lose the natural cushioning in the heel.  You can get skin discoloration that may turn it lighter or even purplish in some instances.   The plantar fascia could also rupture as a result of prolonged administration of steroids.  These are very remote possibilities but still present.

NSAIDS:

These are over the counter MOTRIN,  IBUPROFEN, ADVIL, KETOPROFEN, or ALEVE.  These medications should be taken as directed on the package inserts.

Prescription NSAIDS are also effective at controlling inflammation and may be recommended in some cases.

ICE:

Using a plastic bottle of water is the prefered method of icing.  You freeze the bottle and then roll the foot over the bottle icing and massaging the plantar fascia.  This is also a no-mess solution to icing for the foot.