While plantar fasciitis is the most common cause of heel pain in runners and non-runners alike, it is not always this soft tissue band that is at fault. The plantar fasciitis that affects most people is similar to an insertional tendonitis. When a tendon is overused or stressed, an inflammatory response typically occurs at the point it attaches to the bone. The fascia is structurally different than a tendon, but the same situation applies. In the case of plantar fasciitis, once the inflammation causing the discomfort is under control, the structural problems that cause need to be corrected to prevent reoccurrence.
Even when the clinical symptoms point to this as the problem it is important to examine the bones. An x-ray allows your doctor to visualize the heel bone, or calcaneus. As largest bone of the foot it is responsible for taking the brunt of your body weight as you walk or step down. This pressure can result in a stress fracture, or bone bruise. Stress fractures can be as painful and serious as true bone breaks. The bones go through the same remodeling process with this type of injury and may require ‘casting’ and immobilization.
Other problems that can occur in this bone, amongst others, are spur fractures and bony cysts. Heel spurs can occur from years of the plantar fascia pulling on the heel bone. Bone grows towards areas of pressure of tension, thus resulting in these bony outgrowths. They almost never are a cause of the pain, but most often the result of not treating heel pain. What can make them excruciatingly painful is a fracture. Fracturing this little spurs creates a loose body to create irritation in the heel. If a fracture of this type is present, surgical excision is usually necessary. Bone cysts are often non symptomatic findings in x-rays. There are many types of bone cysts; proper diagnosis and treatment may require advanced modalities like MRI.