Heel pain is nearly always related to injury to a ligament called the plantar fascia. This thick, rubbery band of tissue begins in the heel and runs to the ball of the foot within the arch, and is separated into three bands. A wide variety of situations can cause injury to this fascia, but by far and away the most common cause is chronic damage to the tissue because of abnormal foot structure. Most people with this condition have flat or flexibly flattening feet that stretch and strain the fascia with every step taken. Over time, and with the right conditions, the fascia attachment at or near the heel bone can become inflamed and thickened, with microscopic tearing upon arising from bed and from a seated position, or after standing or moving for a lengthy period of the time. The infamous heel spur is related to this strain. While heel spurs are rarely ever the source of pain (despite the common myth they cause heel pain), they do form benignly as a result of the strain on the outer layer of the heel bone connected to the fascia.
High arches cause plantar fasciitis and heel pain due to poor shock absorption in the foot from a lack of flattening ability. The fascia becomes inflamed as a result of this constant shock. High arches are seen less frequently than flat arches, and therefore high arch related foot pain is seen less commonly. People with 'normal' arches can still develop plantar fasciitis from straining injuries. This can occur when ladders or stairs are used in excess, when one steps on a blunt object, or during athletic activity such as running sports.
There are a number of other less common causes for heel pain that are not related to the plantar fasciawdsc. These include nerve pain from a pinched nerve in the ankle or lower back, stress fractures of the heel bone, rare bone tumors, pain from body-wide arthritic conditions like rheumatoid arthritis, nerve damage from conditions like diabetes, and simple heel pad bruising.
The reasons a podiatrist is the best physician to treat heel pain essentially lie in the nature of what causes most cases of heel pain. Since the majority of heel pain is due to one's foot structure, a deep understanding of the structural mechanics of the foot and how to modify it is necessary in order for treatment to be successful and lasting. Simply put, if a physician does not alter the foot structure by supporting a flat foot or providing shock absorption to a high arched foot, the condition will simply continue to progressively develop, even after temporary relief afforded by medical treatment. Many (if not most) cases of plantar fasciitis can be improved with anti-inflammatory medication, stretching, icing, and steroid injections. These measures will often reduce the pain by reducing tissue inflammation. However, unless the structure of the arch is supported, plantar fasciitis will return following its 'cure' as the underlying cause is not controlled. Primary care doctors are able to start their patients on prescription medication and stretching, and some may give an injection. Many also are able to recommend a store- bought insert (of which many are inadequate to significantly help with plantar fasciitis). Unfortunately, most primary care doctors have little to no foot biomechanics training, and cannot properly assess fully one's foot structure. This is something podiatrists specialize in. The use of better quality temporary pre-made inserts as well as long term use of custom made functionally correcting prescription inserts are part of a podiatrist's treatment and expertise.
Another reason podiatrists are better suited to initially treat heel pain lies in the fact that they treat this condition multiple times a day, week after week. This experience allows the podiatrist two advantages. One is that a podiatrist can better identify if multiple causes are in place creating heel pain (for example plantar fasciitis and nerve inflammation), and if the heel pain is due to less common causes. This leads to a faster, more accurate diagnosis, and to more effective initial treatment. The second advantage a podiatrist has is that they are able, through experience, to determine the most effective treatment course. Plantar fasciitis responds not just to one or two types of treatment, but to multiple treatments at the same time. This includes a mix of inflammation reduction, mobilization of the fascia through the right stretches and possibly a stretching splint worn at night, and structural support. Within each of those treatments, variations may need to be made based on the individual foot. Also, the timing of the treatment needs to be specific. For example, a single injection of steroid compound in the heel periodically rarely is effective, but several injections (up to three) split apart by two weeks works in the majority of cases. A podiatrist can also recognize treatment failure relatively quickly, and move on to other treatments, including physical therapy, immobilization of the foot, or surgery (which is done on only a small percentage of heel pain patients)
By seeing the podiatrist first, one can have a more accurate diagnosis given at the time of the initial visit, and more effective treatment can be performed that will lead to long lasting resolution of the heel pain. Unfortunately, there are some impediments to getting this care first. Some insurance plans, particularly managed care, require a referral by one's primary care doctor in order to see a specialist. Many family physicians will need to evaluate their patient first in order to make the referral, as it is difficult to make the right specialist referral just based on a phone call. This will lead to a delay in treatment. Some primary care doctors at that point may prefer to try their own treatment initially, or may refer to the local general orthopedic surgeon for care. While some orthopedic surgeons are trained specially in the foot and ankle, many have limited experience in treating non-traumatic foot injuries and have little training in foot biomechanics. Another impediment to podiatric care occurs if one lives in a rural area that lacks specialists, forcing one to drive great distances to see a podiatric physician.
Heel pain is common, can be chronic if not properly treated, and generally needs the care of a foot specialist in order for it to be gone for good. By seeing a podiatrist first when heel pain develops, one can avoid a time delay, receive accurate care, and save money by receiving specific and specialized treatment to ensure the condition does not return.