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Inflammation of the fascia on the bottom of the foot is the most common cause of heel pain. The plantar fascia is a structure that runs from the front of the heel bone (calcaneus) to the ball of the foot. This dense strip of tissue helps support the arch of the foot by acting something like the string on an archer's bow. As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This is just like the string on a bow is stretched by the force of the bow trying to straighten. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body. As this process of injury and repair repeats itself over and over again, a bone spur (a pointed outgrowth of the bone) sometimes forms as the body's response to try to firmly attach the fascia to the heel bone. This appears on an X-ray of the foot as a heel spur.


Heel pain probably comes from several causes. In some cases the heel spur can be so big it causes pain itself, but this is rare. The chronic inflammation of the fascia itself may be the source of pain in many cases. This condition is probably most accurately called plantar fasciitis. As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates. This can lead to inadequate padding on the heel and chronic pain in this area. Poor flexibility of the calf muscles, no arch support, a sudden increase in one's level of activity, excessive pronation, repetitive stress conditions (long distance running) poor footwear, excessive walking on hard surfaces, and being overweight are all possible contributors to plantar fascitis.


The pain is typically located at the front of the base of the calcaneus. Less often, the pain extends along the arch of the foot, although sometimes it can be felt in the middle of the foot. The pain is usually worse in the morning when the foot is first placed on the floor and also becomes worse after prolonged weight bearing activities.


The goals of the physical therapy sessions are to decrease the inflammation at the plantar fascia, improve the joint mechanics of the ankle and the foot as well as to improve the flexibility of the calf muscles and plantar fascia. Therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine to the sore area. A customized foot orthotic may be designed to support the arch of the foot and to help cushion the heel or your therapist may recommend you use a heel cup. Ideas are offered for you to use at home, such as doing your stretches for the calf muscles and the plantar fascia.