Heel Pain
What causes it?
Pain in the heel region of the foot leading to problems in walking is a common complaint and can have many causes. Pain felt underneath the heel is most commonly caused by plantar fasciitis. Rarer causes include conditions such as arthritis, nerve entrapment, and stress reactions.
Who is affected and how?
This commonly affects middle-aged people and develops spontaneously. Typically symptoms are worst early in the morning or after periods of inactivity (office job). They interfere with walking and unless treated actively can become chronic lasting many months or even years.
What can be done?
Plantar fasciitis pain often initially respond to anti-inflammatory medication, heel gel pads or cushions as well as (esp early morning) stretching exercises. Physiotherapy can back these up with massage, heat and ultrasound. Second-line measures include steroid injections and night splintage. Extracorporeal shockwave therapy (ESWT) has been shown to be helpful in therapy resistant cases in around 60-70%. Very rarely and in longstanding cases where everything else has failed, can a surgical release (keyhole or open) be indicated but generally only improves symptoms in up to 2/3 of cases.