Justin Brohard, DO, is a foot and ankle surgeon with Salem Health Orthopedics. The orthopedic surgeon said there are many things that could cause pain in the heel of the foot.

Plantar fasciitis

Plantar fasciitis is the most common reason for pain on the bottom of the foot, which can extend out from the heel.

“Often, it’s worse in the morning and can cause pain with walking,” said Dr. Brohard. “It can be caused by injury, such as a bruise, but often it’s due to age and caused by wear and tear in patients 40 to 60.”

Dr. Brohard said these patients often have tightness in the Achilles that contributes to pain in the bottom of the foot. Typically, he starts with imaging in the clinic to rule out stress fractures.

“Bone spurs on the heel are common,” said Dr. Brohard. “Often, patients with plantar fasciitis will have those spurs, but it’s actually the inflammation of the soft tissue that causes the pain. You don’t need to remove the spur most of the time.”

The orthopedic surgeon recommends conservative treatment for plantar fasciitis, as most patients will improve without surgery. That includes stretching, ice and changes to the shoes. Cortisone injections can also help with pain relief.

Dr. Brohard encourages his patients with plantar fasciitis to go through six months of non-operative treatment and then an MRI before considering surgery. If surgery is needed, there are two options.

“Plantar fasciitis release is generally a partial release of the plantar fascia,” said Dr. Brohard. “We remove a small section of the scar tissue and inflamed tissue to prevent it from reforming in that area.”

The orthopedic surgeon said that’s about 90% effective. In patients who also have a tight calf muscle, release surgery can also relieve tension through the Achilles. That surgery is about 85% effective.

Achilles tendonitis

With Achilles tendonitis, pain is on the back of the heel instead of the bottom of the heel. Injury can set off the inflammation, but tightness is often the cause.

Nonoperative treatment options for Achilles tendonitis are the same as plantar fasciitis; however, Dr. Brohard does not recommend cortisone injections.

“For patients who don’t get better within six months, the options are calf release surgery or partial detachment of the Achilles and then attaching it back to the bone,” he said.

Recovery for the latter is about six months in total, with six weeks without weight bearing in a cast and then a boot, but brings a greater chance of healing.

“If a patient doesn’t have tightness or they have a lot of tissue damage, we’ll often recommend the detachment and reconstruction surgery,” said Dr. Brohard. “That surgery is about 95% effective.”

Stress fractures

Dr. Brohard said stress fractures are normally caught early.

“Usually, with stress fractures, healing means a period of not bearing weight and wearing a cast,” he said. “In some cases, screws are needed to reinforce the bone, but that’s rare.”

People who are at risk of stress fractures are those with malnutrition, osteoporosis or a lack of vitamin D as well as athletes. 

“Bone health is an important topic,” said Dr. Brohard. “If you have osteoporosis or are at risk, that should be treated as needed.”

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