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Heel pain is perhaps the most debilitating foot ailment one can get .Considering that the heel bone is the largest of the 26 bones in the human foot and is responsible for stabilizing the body's center of gravity during the first phase of gait. There are many causes of heel pain and naturally many new and expensive "miracle" treatments for the condition. What I will attempt to do in my modest presentation is to highlight the real common causes and sound treatment regimens for heel pain. Based on 22 years of clinical practice treating the average person as opposed to star athletes as some practices like to boast about.

The basic common causes of heel pain are the following:

Heel spurs:  a bony growth on the underside of the heel bone. They are caused by strain on the muscles and ligaments on the bottom of the foot stretching the long band of connective tissues the heel and the ball of the foot.

Plantar fasciitis: An inflammation of the band of fibrous connective tissue running along the bottom of the foot.


Achilles Tendinitis: Pain at the back of the heel caused by inflammation of the Achilles tendon due to overuse and strain of the tendon over time. The fibers of the tendon can tear and causes inflammation, pain and possible bone spur at back of heel where the tendon inserts.


Stress risers or fractures: Repeated trauma to the same area of the heel either through miss step or strenuous activity can lead to small stress fractures to the heel that can be undetectable in regular radio graphs.

Arthritis: Most of the documented arthritic conditions such as osteoarthritis, rheumatoid, gout, etc. can produce heel pain.

Diagnosis of the cause of the heel pain is of paramount importance. So for once I will be somewhat biased and suggest you seek treatment from an expert and see a podiatrist. It is simply a matter of numbers. Who would you rather see? A doctor who sees 10 patients with foot pains a year or an expert who only treats the foot.


Once a definitive clinical diagnosis is made as to the cause of the heel pain, it must be noted that the literature points out that about 85% heel pain cases respond to conservative care. This would include oral or inject able anti-inflammatory medication, exercise, taping, shoe inserts and physical therapy. So what about the other 15% of patient population that isn't being relieved by conservative care and for whom the condition becomes chronic?

For this patient population there is a whole new gambit of new advanced and expensive treatments. Most of which are not covered by any insurance. I will briefly review some of the most popular modalities.

Extra corporal shock wave therapy (ESWT) uses shock waves to break up scar tissue and allow healing of the inflamed tissue. The research on this modality indicates it is moderately successful in younger active patients.


However less effective in middle aged over weight patients. Laser treatment with level IV lasers. This modality uses high penetration laser waves to achieve the same result as the ESWT. The literature points to modest results with the same demographic as the ESWT. Radio frequency neuro ablation of the inferior calcaneal nerve. This is the branch thought to be the most affected in heel pain. Although an FDA approved modality for nerve entrapment in other parts of the body. My clinical experience has taught me that without addressing the actual cause of the heel pain. This treatment is no more effective than a steroid injection. So what is a patient with chronic heel pain to do?

First of all let's look at what are the usual causes of chronic heel pain. My experience, even in cases of conditions such as arthritis, usually points to two major causes, biomechanical and lifestyle.

What do I mean by biomechanical?

Plantar heel pain is mostly the result of mechanical overload of the central band of the aponeurosis. It is by definition a degenerative condition rather than an inflammatory process. It is caused by how the patient's foot type (I.e. flat feet, rigid feet, etc.) affects one's gait. The best way to relieve this mechanical is by orthopedic evaluation of patient's foot type and casting them for a custom foot orthosis. This is not to be confused with a prefabricated insert sold at drug or shoe stores. Studies have shown that custom orthotics relieve heel pain by improving the foot's alignment.

So what do I mean by lifestyle changes? Put down the bag of Doritos and listen up. Studies have shown that every five pounds of excess weight in the body is the equivalent of 25 additional pound of weight on our joints. This statistic is staggering. In my experience the vast majority of patients with chronic unresolved heel pain are at least 25 pounds overweight. I always insist these patients make the necessary healthy dietary changes to promote healthy weight reduction. You would be amazed how much relief of pain can be achieved by losing just 10 pounds. However, it is a permanent nutritional change that is being advocated here as opposed to a quick fix diet.

What I have brought to your attention is for the purpose of making you as a consumer both informed and skeptical when you go out into the healthcare market. Do not accept the heavily marketed wonder treatment as a solution just because it is offered by a doctor. Ask question of your physician and always make sure a thorough evaluation of your condition has been done.