One of the most common presentations of pain I see in practice is at the heel. The heel, or calcaneus, is the largest bone in the foot. There are a number of conditions that can cause heel pain, but the two most prevalent conditions I diagnose are plantar fasciitis and calcaneal fat pad syndrome (CFPS). These two conditions can present quite similarly and as such are often mis-diagnosed as plantar fasciitis even though they are truly CFPS, and vice versa. Plantar fasciitis is the most common source of heel pain and often has been described as walking on a pebble. Plantar fasciitis is pain primarily located at the bottom of the heel and is typically worse first thing in the morning or after prolonged periods of sitting or rest. After walking around for a while, the pain usually starts to subside but then can worsen after extended periods of weight-bearing activity.
The plantar fascia itself is composed of thick connective tissue that extends from the heel to the base of the toes. Its purpose is to support the arch of your foot and act as a shock absorber for any weight-bearing activities. The pain associated with plantar fasciitis is often described as both dull and achy as well as sharp and burning when at its worst. The pain is isolated to the inside front of the heel but can radiate into the mid-arch as well. Plantar fasciitis has long been thought to be the result of inflammation of the fascia however more recent research has shown that degeneration or weakening and small tearing of the fascia is more likely the primary cause. Heel spurs are often associated with plantar fasciitis however they don’t by default go together. The constant deterioration and irritation of the plantar fascia can create irritation of the heel bone and can develop in 50% of plantar fasciitis cases.