Heel or Arch Pain

Heel or arch pain may occur in an older person simply because the fat padding that lies between the bones and the skin becomes thinner with aging. Pain also may be due to repetitive activity, such as going down stairs often; this increases pressure on the arch and in the heel. Heel or arch pain may also be a symptom of a larger problem.

The most common cause of heel pain is a pointy outgrowth of bone (spur). Pain results when the foot presses against something at the site of the spur. A spur can also cause pain if a person alters the way in which he walks to keep pressure off the foot. Doing so stretches the Achilles tendon and the flat sheet of connective tissue on the bottom of the foot (plantar fascia) where they attach to the heel. Inflammation of the Achilles tendon (Achilles tendinitis) and of the plantar fascia (plantar fasciitis) adds to the pain.

See the figure What Is a Heel Spur?

Heel pain can also result from inflammation of the sac situated between the large bone in the heel and the Achilles tendon (Achilles bursitis). Diseases such as rheumatoid arthritis and gout sometimes cause heel pain as well.

Diagnosis and Treatment

A doctor determines the cause of heel pain by reviewing the person's symptoms and examining the foot. X-rays may be performed to look for abnormalities such as spurs.

Treatment depends on the cause. Pain due to thinning of the fat pad on the bottom of the foot may be relieved simply by using inserts (orthotics) in footwear. Inserts provide more padding and support for the heel or arch. Some inserts are sold without a prescription, but others are prescribed by a doctor or a foot doctor (podiatrist) and are fitted by a doctor, foot doctor, or orthotist (a person skilled in the fitting of devices such as braces, splints, and inserts).

Nonsteroidal anti-inflammatory drugs (NSAIDs) are sometimes taken by mouth to relieve the pain caused by bursitis and fasciitis. Injections of a corticosteroid and a numbing drug (anesthetic) are sometimes given for severe pain.

Shock wave therapy may help relieve pain if drug therapy is ineffective or may be used instead of drug therapy. A dome-shaped device, placed on the skin over the painful area in the heel, is used to generate the shock waves.

Surgery is sometimes needed to remove a bone spur that is causing pain. However, spurs sometimes recur.