The two most common causes of pain in the bottom of the heel, the arch, or both the heel and the arch, are heel spurs and plantar fasciitis. A Heel Spur is a piece of calcium or bone that sticks out from the bottom of the heel bone, and lies within the fibers of the plantar fascia. When walking, the spur digs into the plantar fascia and causes small micro-tears in the plantar fascia. This produces inflammation and pain in the heel, which at times may radiate into the arch.
Heel spurs develop in some people that have a condition called plantar fasciitis, inflammation of the plantar fascia. Heel spurs form when the plantar fascia separates from the calcaneus. An abnormal bone growth, a hook-like spur, forms from calcium deposits that grow at the site of inflammation. Heel spurs are more common in middle-aged adults and people that have had plantar fasciitis for a long time. People with flat feet or high arches are vulnerable to heel spurs. Women who wear high-heeled shoes are more susceptible, as well.
Heel spur and plantar fasciitis pain usually begins in the bottom of the heel, and frequently radiates into the arch. At times, however, the pain may be felt only in the arch. The pain is most intense when first standing, after any period of rest. Most people with this problem experience their greatest pain in the morning, with the first few steps after sleeping. After several minutes of walking, the pain usually becomes less intense and may disappear completely, only to return later with prolonged walking or standing. If a nerve is irritated due to the swollen plantar fascia, this pain may radiate into the ankle. In the early stages of Heel Spurs and Plantar Fasciitis, the pain will usually subside quickly with getting off of the foot and resting. As the disease progresses, it may take longer periods of time for the pain to subside.
Heel spurs and plantar fasciitis are diagnosed based on the history of pain and tenderness localized to these areas. They are specifically identified when there is point tenderness at the bottom of the heel, which makes it difficult to walk barefoot on tile or wood floors. X-ray examination of the foot is used to identify the bony prominence (spur) of the heel bone (calcaneus).
Non Surgical Treatment
Bone spurs rarely require treatment unless they are causing frequent pain or damaging other tissues. Because heel spurs and plantar fasciitis are so closely related, they are usually treated the same way. Symptomatic treatment involves rest, especially from the activity that is contributing to the condition and making symptoms worse (although this may not be easy to discover, as problems can manifest several hours or days after the harmful activity has occurred). If you identify the offending activity, ice is recommended immediately following it. Stretching of the calf muscles after a short warm up is also a good idea and can be helpful. Stretching exercises that gently lengthen the calm muscle will relax the tissue surrounding the heel and should be done several times a day, especially in the morning and after prolonged sitting.
Surgery is used a very small percentage of the time. It is usually considered after trying non-surgical treatments for at least a year. Plantar fascia release surgery is use to relax the plantar fascia. This surgery is commonly paired with tarsal tunnel release surgery. Surgery is successful for the majority of people.