Athletes and other active individuals are susceptible to heel pain, which is usually an overuse problem. The typical symptoms are pain in getting out of bed in the morning, and the sensation of a stone bruise on the bottom of the heel. Pain can also occur during or after activity, and may be accompanied by arch fatigue. This is such a common problem, in children and adults, that we will devote much of this article to detailing the cause, and then describe the necessary, general treatment.

Inflammation, recall, is your body's response to injury - often presenting as swelling, heat, and pain, "-itis" is the suffix used to indicate the location of the inflammation and which tissues are "angered" or injured. Understanding some of the simple anatomy of the heel can help visualize the problems occurring in heel pain and thus the means of treatment. As we identify structures, and tissues, realize that injury or stress of each of these may be the cause of inflammation.

Starting about the level of the knee, in the back of the leg, is the calf muscle, which connects into the achilles tendon, the wide band behind the ankle. The achilles tendon attaches to the back portion of the heel. Underneath the heel bone (or calcaneus) is a fat pad for shock absorption. Also connected to the bottom of the calcaneus, is a ligament (called the plantar fascia) that forms the arch. Each step taken by the foot relies on the achilles tendon and the plantar fascia. If the foot is too high arched or too flat footed, there will be too much stress at the heel where the plantar fascia attaches. Often a tight or short achilles tendon will cause stress to be placed on the plantar fascia due to its pull on the heel bone (in an opposing direction). These most-stressed areas may become inflamed, causing pain at the attachment to the calcaneus, under the heel). It is possible for a heel spur to form along with this inflammation. Bursitis may also occur, as an inflammation of a protective fluid-filled sac under the heel. Occasionally, even a stress fracture of the calcaneus will occur; this would be diagnosed with an X-ray.

Speaking of X-rays and fractures, let's take a look at children's bones. You may already know that the way bones "grow" - or lengthen - is by a growth plate, usually near the end of the bone. With maturity, these growth plates fuse or harden. Before that time, they are soft areas of growth, quite susceptible to fracture, or breakage. Heel pain in kids and early teens may be a result of the same forces mentioned above - primarily the achilles tendon and the plantar fascia. The weakest spot on the heel bone, the growth plate, may become inflamed (termed "apophysitis") as it is "tugged" by the two stresses and overuse. The symptoms in the child are similar to those in the adult, with more pain during and after activity. An X-ray will help determine the extent of injury, which can be serious enough to require casting the foot and leg for an appropriate time of rest.

Treatment of heel pain - be it from the process of spur formation (in adults), apophysitis (in kids) or plantar fascitis (in all ages) - is two fold. First, it is necessary to relieve the immediate or "acute" symptoms. Anti-inflammatory treatment consists of ice therapy, oral medications and perhaps injection, if the symptoms have been persistent.

Secondly, the foot must be controlled to prevent the abnormal stresses. This will help the symptoms at hand, but more importantly, avoid recurrence of the problem. Control usually begins with some form of arch support. Cleats notoriously have no cushion in the arch, and the added support may be in the form of an insert from the drugstore, or a custom molded orthotic. Orthotics not only support the arch, but allow the foot to function more efficiently by the custom prescription. We often will tape the foot with a temporary rest strapping as an immediate benefit, as well as a test to determine if orthotic control will be successful.

A stretching program for the achilles tendon and arch area is also a necessary complement to treatment. This keeps the foot flexible to deal with the stresses of running, jumping and of course, kicking!

Once Treatment is implemented, it may take as little as a week or as long as three months to completely recover from the heel pain. Activity does not usually have to stop, as long as care is taken to prevent recurrence of the original stress that has caused the pain and inflammation in the first place.

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