In adulthood, one of the most frequent reasons of consultation is the heel pain at the sole, also known as “plantar fasciitis”. It often begins without apparent cause and is usually more intense on waking in the morning or after walking for a long time. An inflammation of the plantar fascia is the most common cause of this pain.
On the x-rays can be seen, in many cases, a calcification at the insertion of the plantar fascia on the heel bone which is called ""heel spurs”. It isn’t usually the cause of pain. Initial treatment should always be conservative, based on the use of silicone heel cups, insoles, night splints, avoiding flat shoes or hard soled, anti-inflammatories, physical therapy, stretching exercises, and injections of steroids. If improvement is not obtained, the doctor would opt for surgical treatment which involves making a small cut in the plantar fascia to loosen it.
Sometimes the pain on the back of the heel (posterior heel pain) creates a conflict with footwear that gives rise to inflammation, pain and bursitis in that area. It is usually due to a chronic inflammation of the Achilles tendon inserted on the calcaneus (heel bone). If a bony prominence (posterior process of the calcaneus) pressures the distal Achilles tendon, this situation can become chronic.
The conservative treatment is similar to the one given to the plantar fasciitis, besides the use of shoes without heels or heel stiffeners. Surgical treatment consists on the removal of the bony peak of the calcaneus bone in order to stop it from making pressure in the Achilles tendon. It is associated with resection of the ill tendon fibers and sometimes ""growth factors""may be added to regenerate the damaged tendon. Sometimes it is necessary to use grafts of the neighbour tendons if the Achilles tendon is very weak in order to prevent the risk of breakage.
