Foot Pain in Heel Bone

  • Foot pain in the heel bone can be usually due to the development of a heel spur.
  • A heel spur should essentially be treated as if though it were plantar fasciitis.
  • Plantar fasciitis is the most common cause of heel pain seen by foot and ankle surgeons.
  • -Massive pain that inhibits you from standing
  • -About 15% of the population suffer from plantar fasciitis.
  • -This is usually an overuse injury at the origin of the plantar fascia caused by excessive stress to the foot or  biomechanical abnormalities of the foot.

    Heel Spur
    Heel Spur


  • -The plantar fascia stretches from your heel (calcaneus) to the joints of all your toes (Metatarsal phalangeal joints)
  • -The plantar fascia consists of 3 bands: medial, central, and lateral.
  • -Usually the medial band is damaged, but it can also be the central band.
  • -The plantar fascial bands are supplied by the medial and lateral plantar nerves.
  • -The thickness of a normal plantar fascia is approximately 3 mm.
  • -In patients with plantar fasciitis, the maximum thickness is significantly increased to 7 mm


  • -Plantar fasciitis is described as a painful inflammatory process.
  • -generally at the origin of the plantar fascia on the calcaneus.
  • -It can also be central in the plantar arch.
  • **It is very uncommon for plantar fascia pain to be on the outside of your foot or toward the toes.

Risk Factors

  • -40 to 60 years
  • -more common in women
  • -High Arch and Flat Foot
  • -Occupations that require standing
  • -Common in athletes, nurses, mailmen, factory workers, mechanics etc
  • -People with footwear that is loose & has no arch support.
  • -Obese patients -this leads to chronic stretching & degeneration & pain.
  • -Pregnant patients- the ligaments get loose and stretch
  • -Tight Calf muscles


  • -Pain is usually localized to the medial calcaneal tubercle
  • -Initially pain is sharp and worse with the first step of the day after a period of non–weight bearing.
  • -Chronically it is dull and painful over time


Diagnostic testing

  • Radiographs(X-rays) – Check for a Heel Spur- this is bone formation at the insertion of the plantar fascia- Note: this is not what causes the pain- but correlates the diagnosis
  • Ultrasounds- Inflammed fascia is normally hypoechoic- but normal fascia is normally iso-echoic
  • MRI- The best method- but almost never needed (highly overkill)


Non-surgical Treatment


Low Dye Strapping

  •  I love this type of taping- it holds the foot in an ideal structure and re-inforces the arch for a couple days until the inflammation of the fascia can die down.
  • Tip 1: ***If low dye taping does work for you- In my experience an orthotic will complete cure your heel pain the majority of the time***

Get the right shoes

  • Tip 1: ***Get atleast a 1 inch heel on your running shoe – according to the Podiatric Sports Association***
  • Tip 2: ***Make sure the shoe bends in the front and not in the middle or the back of the shoe**
  • Tip 3: ***Avoid sandals & going barefoot on hard surfaces**

Stretching of the Achilles Tendon and Plantar Fascia

  • Tip 1:***Studies show that stretching your achilles tendon 3x per day for 2mins at a time will cure the pain in 25% of
  • people***
  • Tip 2:**Stretching your feet(the plantar fascia) as well as the Achilles tendon boosts that number from 22% to 55%
  • according to studies!*** So start stretching immediately!
  • Tip 3:***Use night splints to stretch your feet for you while you sleep!***

Night Splints

  • Wear these at night to keep your feet stretched (the toes point straight rather than down when you sleep)
  • Tip 1: ***Studies show that night splints helped almost 100% of patients***
  • Tip 2: ***Ease into them while napping, you forget you are even wearing them after 1-2 naps!***

Physical Therapy

  • Studies show good relief after 2-4 weeks when combined with anti-inflammatory medications & ice.
  • Ultrasound & whirlpool therapy also helps greatly.
  • No exact numbers available from studies.

Anti-inflammatory Medication:

  • Take a 2 week regimen of regular advil, Ibuprofen or any other NSAID(see pharmacist for dosing).
  • Watch for allergies.
  • Topical NSAIDS are frequently helpful- but no exact numbers are available from studies.

Injection of Corticosteroids:

In my experience- **this is the gold standard for immediate relief!** Fixed with a 5 minute visit to the podiatrist.

  • Tip 1:***Studies show almost all people recieve temporary relief that last for up to 6-8 weeks, in about 25% it never comes back***
  • Tip 2: If you remove the cause during the pain-free injection period(6-8weeks) then the pain should never come back.


***The long term Gold Standard- whereas corticosteroids are the short term gold standard***

  • Tip 1: ***Orthotics combined with anti-inflammatories & Injections have an 85% permanent cure rate for plantar fasciitis! Compared to just 30% without orthotics***
  • Tip 2: Get some arch supporting orthotics like PowerStep (25$) not the gel inserts of Dr. Scholl – they just cushion but not support the arch.
  • Tip 3: Get some heel lifts if you can over Dr. Scholl, but PowerSteps are better than both.
  • Tip 4: Powersteps > Heel Lift > Dr. Scholl Gel inserts

Extracorporeal Shock-Wave Therapy
Sound waves are propagated to damaged tissues to induce microtrauma.This microtrauma stimulates healing by attracting blood vessels and nutrients to the plantar fascia.

  • Tip 1:*** Used as a last ditch effort before surgery if you are rich- because it is not covered by any insurance***
  • Tip 2: I say avoid it- its expensive and unproven!

Surgical Treatment

Studies show that only 5-10% of people will ever need surgery on their Heel for Plantar Fasciitis.

Open Plantar Fasciotomy

  • -Open plantar fasciotomy allows for release of the tight plantar fascial bands.
  • -Studies show that this surgery is 37% effective with a fascial release only & 45% successful in curing with fascial release as well as removal of the bone spur.
  • -Most do experience relief-

Endoscopic Plantar Fasciotomy ***Great choice***

  • -Popular due to minimally invasive nature.
  • -Minimizes complications and recovery time compared with open procedures.
  • -A scope is inserted through a very small incision and the fascia is resected.
  • -Satisfaction ranged from 60% to 80% with this procedure in relief of heel pain.


  • -Percutaneous cryosurgery uses subfreezing temperatures to produce analgesic effects.
  • -Nerves are detected & frozen for 3 mins, then thaw for 30 seconds & repeated.
  • -Numbness will occur for many months.
  • -Research shows 78% success – but more research is still needed for this procedure.

Radiofrequency Nerve Ablation

  • -Another minimally invasive procedure that ablates the nerve with an electrode through the skin.
  • -Patients are allowed to bear weight immediately after the procedure.

Coblation Therapy

  • -Coblation therapy with Topaz is a form of bipolar radiofrequency.
  • -causes microscopic damage to the fascia, which increases the blood supply to the fascia; this causes it to rebuild and flood the area with growth factors.
  • -Patient shouldn’t walk for 3 weeks.