Heel Pain Causes
One of the most common causes of heel pain is plantar fasciitis. If your heels hurt, are tender, or bother you in the morning with your first few steps it may be plantar fasciitis.
Plantar fasciitis typically causes pain in the bottom of the heel. People who have plantar fasciitis know how it classically hurts first thing in the morning and it hurts when they gets up from sitting, this is called post-static dyskinesia. Post-static dyskinesia can simply be referred to as pain after rest. Other common causes of heel pain include Achilles tendonitis or Achilles tendonosis and heel spurs.Many of the other causes of heel pain that are part of the differential diagnosis for plantar fasciitis, do not have this poststatic dyskinesia or first thing in the morning heel pain. With plantar fasciitis, limping in the morning is classic. If you experience these bouts of heel pain read more about plantar fasciitis.
The most effective long-term treatment is an custom prescription orthotic with a very deep heel cup that actually has a hole in the bottom of the heel but is filled with 1/8 inch neoprene it is covered with a special cushioning material called poron and has a cushioned top cover on the entire orthotic including the deep heel cup area. This way, one is using the natural contour of the heel and the existing fat pad to help cushion the bottom weight-bearing portion of the heel bone. In chronic cases that do not fully respond to mechanical treatment including the special orthotics, and we will occasionally do a low dose ultrasound-guided cortisone injection. In this case the cortisone is injected directly at the layer between the plantar fascia and the fat pad. The goal is to avoid injecting into the fat pad.
Not All Heel Pain is Plantar Fasciitis
While almost 90% of heel pain is Plantar Fasciitis, not all heel pain is caused by this condition and that is why we need to see you and examine your feet to find out the real cause of the pain you are experiencing. Once we determine the underlying cause of your heel pain, we can recommend many treatment options.
At our clinic, we have seen patient’s over the years that had these classic plantar fasciitis symptoms. However on further examination, they have a very thin plantar fat pad and with diagnostic imaging such as diagnostic ultrasound imaging the plantar fascia shows no inflammation or edema. Some of these individuals also have a very high arch foot structure so that the contact points of the heel and the forefoot are more intense and focal than someone with a flatfoot or even a normal arch. With this problem, people are virtually walking on the heel bone. Some people are structurally born and develop this way. Other people have a normal healthy fat pad cushion, but over time the fat pad breaks down causing this problem. It is more common as one gets older. This is also called atrophy of the plantar fat pad or atrophic plantar fat pad.
To effectivly treat heel pain a medical evaluation by a podiatrist or heel pain specialist is necessary. Over-the-counter orthotics or heel cups can help soothe the pain, however the condition may not improve unless properly treated after a proper medical evaluation to determine the cause of the pain.
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The Seattle Heel Pain Center is a division of Issaquah Foot & Ankle Specialists