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The most likely cause of heel pain is plantar fasciitis, which is a painful inflammation of the plantar fascia, a tough band of tissue that starts at the bottom of your heel and travels along your arch all the way out to the toes. Plantar fasciitis is an overuse injury that is more common in older individuals and usually pops up out of nowhere. Typically, patients complain of stabbing pain in their heel when they step on the ground, particularly when they first get out of bed in the morning.
Luckily, plantar fasciitis resolves in most people over time without surgery. There are plenty of non-surgical treatment options which can be used in combination with each other including gel heel cups for your shoes, a splint to wear at night, anti-inflammatories like ibuprofen, and most importantly, stretching and massaging the plantar fascia origin.
It is important to be patient: it can take a long time (up to 6 months to a year) for plantar fasciitis to get better with non-surgical treatment. If pain persists, other treatments, such as shock-wave therapy and injections (both steroid and platelet-rich plasma), can be tried. While steroid injections can be effective for pain, I generally do not recommend them, especially in athletes, because they probably increase the risk of future plantar fascia tears. Surgery is a last resort and is very rarely necessary.
There are other less common causes of heel pain. Pain, swelling and a bump at the back of the heel are typical of insertional Achilles tendinitis. This can often be treated effectively by using a heel lift, anti-inflammatories and rest. Pain in the heel with running could be a stress fracture and should be evaluated by a physician. Any pain associated with numbness or tingling on the bottom of the foot could be tarsal tunnel syndrome, which is the foot’s equivalent of carpal tunnel syndrome, and should also be evaluated.
While many foot problems can be treated without surgery, persistent pain that doesn’t seem to be responding to non-operative treatments should be evaluated by an orthopedic foot and ankle surgeon.
Through HSS Orthopedics at Stamford Health, I am privileged to now be able to make world-class care more convenient for Fairfield County residents. My office is at the HSS Stamford Outpatient Center at Chelsea Piers, and my colleagues and I perform surgeries at both Tully Health Center and Stamford Hospital, in addition to Hospital for Special Surgery in Manhattan.
