There are a variety of causes for heel pain and the patient's weight is often an exacerbating factor. The most common condition is plantar fasciitis, which is a strain of the strong ligament band that runs from under the heel bone (calcaneus) to the ball of the forefoot. High tension and small (micro) tears can develop causing low grade chronic inflammation and pain, classically increased after a period of rest ("1st step pain").
Treatment of Heel Pain
An initial anti-inflammatory injection under local anaesthetic is very useful before commencing stretching, icing, oral and anti-inflammatory gels, and orthotics (insoles). 90-95% of patients will be cured within a year. Where symptoms remain, heel surgery involving a quick and simple lengthening procedure can be undertaken for patients with continued plantar fasciitis, which is 90% successful. Other causes are nerve irritation/entrapment, and benign (non-cancerous) soft tissue lumps, but this list isn't exhaustive and scans such as ultrasound, x-ray and MRI may be required. Bone spurs have previously been cited as a cause of heel pain but they are now considered to be a side effect of the plantar fascia pull on the heel bone. They are often an incidental x-ray finding without causing any pain at all.