The heel of a persons foot consists of the heel bone, a pad of fat which acts as a protective cushion and a layer of thickened skin. An intense, sharp pain at the bottom of the heel may be caused by a heel spur. This growth of extra bone on the calcaneus or heel bone is believed to form when the connective tissue that extends from the heel bone to the base of the toes pulls excessively on the heel. As this extra bone forms it causes a continuous pain that seems to become less painful as the foot adjusts to it. Certain disorders such as an abnormal flatness of the arch and sole of the foot, as well as those that cause the heel cord to always be contracted can increase the risk of heel spur.
During the time that a heel spur is developing it can be especially painful while a person is walking. From time to time a fluid pocket called a bursa will develop beneath the spur causing inflammation. Known as inferior calcaneal bursitis, this condition will usually cause a throbbing type of pain. But it is possible for a bursa to form even when a heel spur is not present. As the heel spur develops the pain may diminish becoming very painful if the area is injured. This is often known to occur in those who play sports. A heel spur can be diagnosed by a doctor during any ordinary physical examination. By pressing the center of the heel the doctor will find a painful area when a heel spur is present. In most cases an x-ray will be taken to confirm the diagnosis even though newly formed spurs may not be detected.
Pain in the heel of the foot can be caused by several different conditions. One which is often found in children is known a Sever’s disease. This disease is caused by damage to the cartilage. As the heel bone develops into two sections, the bone remains soft. Between the ages of 8 and 16 the bone will harden completely and the two parts are connected by cartilage. Excessive activity or strain can break the cartilage causing pain along the edges of the heel. This condition is treated by placing heel pads in the shoes. Posterior Achilles tendon bursitis is caused when a person walks in such a way that the soft tissues behind the heel are repeatedly pressed against the hard back support of a shoe. In this case the pain is caused by an inflammation of the bursa which is located between the skin of the heel and the Achilles tendon. It is characterized by a hard, tender, red area high on the back of the heel. As the bursa becomes more inflamed it may appear as a red lump under the skin of the heel causing pain both at and above the heel. This condition is treated by eliminating the pressure, injections and sometimes surgery.
In most cases heel spurs are treated to relieve the pain using a mixture of local anesthetic and corticosteriods which is injected into the heel. The use of orthotic inserts in the shoes may be necessary to help stabilize the heel by minimizing the stretching of the fascia and to reduce the pain. This is sometimes done in conjunction with wrapping the arch with padding to better immobilize the foot. Although a heel spur can be very painful, most will resolve themselves without surgery. But in some cases the spur may be surgically removed if the constant pain is interfering with walking. Even so, there are occasional cases where the pain will persist even after surgery.