Causes of heel pain
The most common cause of heel pain is plantar fasciitis — inflammation or degeneration of the thick band of tissue (plantar fascia) that runs from the heel bone to the toes. Classic plantar fasciitis pain is worst with the first steps in the morning, improves with activity, and worsens again after prolonged standing or sitting.
Other causes include fat pad atrophy (thinning of the protective fat pad under the heel bone, more common with age), Achilles tendinopathy (pain at the back of the heel where the tendon attaches), calcaneal stress fractures, and less commonly, nerve entrapment or systemic inflammatory conditions. Accurate diagnosis is essential because treatment differs between these causes.
- Plantar fasciitis — pain under the heel, worst with first steps in the morning
- Fat pad atrophy — pain directly on the heel bone, worse on hard surfaces
- Achilles tendinopathy — pain at the back of the heel, worse with activity
- Calcaneal stress fracture — deep heel pain, focal tenderness on squeezing
- Baxter's nerve entrapment — burning pain, often confused with plantar fasciitis
- Heel spur — bony growth on the heel bone (often incidental finding)
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Treatment approaches
The majority of heel pain (particularly plantar fasciitis) responds to conservative treatment within 6–12 weeks. The core components include stretching (calf and plantar fascia), appropriate footwear with adequate cushioning and arch support, orthotic insoles (prefabricated or custom), activity modification, and simple pain relief.
For persistent cases, options include night splints, extracorporeal shockwave therapy, corticosteroid injection (used judiciously due to fat pad atrophy risk), and in rare cases, surgical release. Dr. Gautam follows a stepwise approach, escalating treatment based on response rather than jumping to invasive measures prematurely.
| Treatment | What it does | Typical timeline |
|---|---|---|
| Calf and plantar fascia stretching | Reduces tension on the fascia | Daily, benefits within 2–6 weeks |
| Orthotic insoles | Redistributes pressure, supports arch | Continuous use, benefits within 4–8 weeks |
| Appropriate footwear | Cushioning and support | Immediate benefit, long-term habit |
| Night splints | Maintains ankle dorsiflexion overnight | 4–8 weeks of nightly use |
| Shockwave therapy | Stimulates healing response | 3–6 sessions, benefits at 6–12 weeks |