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My 17 year-old daughter complains of left heel pain first thing in the morning. It seems to go away during the day and gets worse again at night. I bought her new shoes but that didn't seem to help. What could be causing this?

There are many possible causes of heel pain. Some of the more likely choices are obesity, plantar fasciitis, Achilles' tendinitis, tarsal tunnel syndrome, and neuroma.

Plantar fasciitis is an inflammation of the fascia or connective tissue along the bottom of the foot. There may be no known cause. There may be a hormonal link as it occurs most often in middle-aged obese or overweight women. Tendinitis of the Achilles' usually causes swelling and tenderness along the tendon.

Tarsal tunnel syndrome is caused by compression of the tibial nerve as it passes under a ligament through a space or tunnel made by the ligament crossing the bones in the ankle. Neuroma is a benign tumor of the calcaneal nerve. All of these conditions are aggravated by obesity and improper shoe wear.

There's enough overlap or similiarity in symptoms for these conditions that a medical exam and possible testing is needed to find out just what is the problem. An orthopedic surgeon or podiatrist can help guide you through the diagnosis and treatment plan.

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