The most common cause of heel pain is a syndrome that physicians refer to as plantar fasciitis. What that means is an "itis" or inflammation of the fascia on the plantar aspect, or bottom aspect, of your foot. This fascia is a soft tissue band-like structure that runs from the inside portion of your heel bone to insert or to attach to the toe region. It helps to give support to the arch of your foot.

There are many reasons why this fascia may become inflamed, particularly in a runner. The most common reason is the fact that the arch of your foot is not sufficient enough for the demands that you place on it and as you run. The fascia is being irritated and overworked. This can lead to pain, most typically presenting on the inside bottom portion of your heel bone.

The treatment for this is to first analyze if there has been any change in your routine. Increasing mileage, adding hill work and running on hard surfaces frequently can be an inciting cause for this pain. Another possibility is that you need new shoes. The present day shoes are made with very durable materials, so we cannot depend on our shoes "wearing out" before we change them. The wearing out of the shock absorbency part of shoes varies somewhat between different brands of shoes. However, the majority of them will show decreased shock absorbency at approximately 300 miles. Therefore, you may need to change your shoes due to loss of their shock absorbency, long before the soles or the uppers wear out.

In more resistant cases of this kind of heel pain, one might take an anti-inflammatory medication, either over the counter or prescribed by a physician. Ice to this region after the run will also help. Additionally, a custom-made orthotics (shoe inserts) for those people with severely flat or pronated feet may be of benefit. Occasionally, an injection of steroids may be used.

The treatment for this is rarely surgical. The bone spur simply reflects a traction phenomena of the bone where this plantar fascia attaches. It is not considered a bone spur similar to those we see with osteoarthritis. Therefore, the bone spur does not need to be removed.