|
Pain is an indication from our bodies that something is not right. We experience pain, after an injury or early in an illness, that may alert us to the fact that our body has suffered damage. Heel pain is a common condition in which weight bearing on the heel causes extreme discomfort. Heel pain usually occurs as the result of abnormalities in walking or foot movement that place too much stress on the heel bone and the soft tissues that are attached to it. This stress may also result from injury, or a bruise sustained while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear; or being overweight.
Causes
The heel bone is the largest of the 26 bones in the human foot. Heel pain can occur in the front, back, or bottom of the heel. Heel pain has its origin deep within the foot, directly on the heel bone or within the foot's connective tissues, called the fascia. Heel pain alerts us to seek care from a podiatric physician. This alert is important to identify which of the many different causes of heel pain is involved.
-
Heel Spurs
- A common cause of heel pain is the heel spur which is a bony growth on the underneath side of the heel bone. A spur appears on x-ray as a protrusion that can extend forward as much as half an inch from the heel bone. Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from abnormalities in walking, running or jogging, improperly fitted or excessively worn shoes, or obesity.
-
Plantar Fasciitis
- Both heel pain and heel spurs are frequently associated with an inflammation of the band of fibrous connective tissue (fascia) that runs along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation of this band of fibrous connective tissue is called plantar fasciitis. It can be quite painful, and is common among athletes who run and jump a lot. This inflammation may be worsened by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.
-
Excessive Pronation
- Heel pain sometimes results from excessive pronation of the foot. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock as we walk. In a normal walking gait, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation, excessive inward motion, can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
-
Arthritis
- Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint, can cause heel discomfort.
-
Bursitis
- Heel pain may also be the result of an inflamed bursa (bursitis) which is a small, irritated sack of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Heel pain caused by bursitis may be associated with a heel spur, or may mimic the pain of a heel spur.
-
Achilles Tendonitis
- Pain at the back of the heel is associated with inflammation of the achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. The inflammation is called
Achilles tendonitis and is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.
-
Bone Bruise
- A bone bruise or contusion, a common heel injury, is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.
-
Stress Fractures
- Stress fractures of the heel bone can also cause heel pain, but these are less common.
Other Causes
-
Other causes of heel pain include, but are not limited to: nerve injuries, heel bone abnormalities, psoriasis, tumors, and collagen disorders. Illnesses like these and others must be diagnosed and treated separately. Your podiatric physician may refer you to a local specialist if the problems are beyond his or her area of expertise.
Treatment
For temporary relief of heel pain:
Soak the heel in ice water to relieve pain and inflammation. This works best by placing the foot in a basin filled with tap water, high enough to cover the heel. Allow the foot to adjust to this temperature. Then add ice cubes (two or three at a time) every five or six minutes over a 30-minute period. Soak the foot in ice water three times daily and immediately after any activity. Heat may also be recommended, but ice is usually preferable. Caution: People with diabetes or poor circulation should not use cold water or ice packs.
Avoid sports and other vigorous activities while allowing time for the foot to heal.
To properly treat heel pain, the following must be accomplished: the shock must be absorbed, cushioning must be provided, and the heel must be elevated to transfer pressure. This can be accomplished with a heel cup, visco heel cradle, or an orthotic designed with materials that will absorb shock and shear forces. When the condition is pronation related (usually plantar
fasciitis), an orthotic to control the pronation will help to prevent the inflammation of the plantar fascia. Footwear selection is also an important criteria when treating heel pain. Shoes with a firm heel counter, good arch support, and appropriate heel height will be the ideal choice.
An examination by your podiatric physician will allow him to determine the cause of your heel pain and outline a treatment regime, which may include: prescription oral nonsteroidal anti-inflammatory medications to reduce both pain and inflammation, cortisone injections to reduce pain and inflammation, foot taping and padding, custom
orthotics, and/or physical therapy.
If nonsurgical treatments do not alleviate pain, surgical intervention may be necessary.
Prevention
A number of things can be done to avoid heel pain and associated problems:
-
Wear shoes that fit well (front, back, and sides) and have shock-absorbent soles, rigid shanks, and supportive heel counters.
-
Wear the proper shoes for each activity.
-
Do not wear shoes with excessive wear on heels or soles.
-
Prepare properly before exercising. Warm up and do stretching exercises before and after running.
-
Pace yourself when you participate in athletic activities.
-
Eat well balanced meals and get an adequate amount of sleep daily.
-
If obese, lose weight.
A
Word About Children’s Heel Pain
Heel pain can also occur in children, most commonly between ages 8 and 13, as they become increasingly active in sports activities. This physical activity, especially jumping, inflames the growth centers of the heels; the more active the child, the more likely the condition will occur. When the bones mature, the problems disappear and are not likely to recur. If heel pain occurs in this age group, podiatric care is necessary to protect the growing bone and to provide pain relief.
|
