Heel Pain
Heel pain is one of the most common conditions treated by podiatrists. It is often a message from the body that something is in need of medical attention. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we have suffered.
Who gets heel pain?
The greatest incidence of heel pain is seen in middle-aged men and women. It is also seen in those who take part in regular sporting activities and those significantly overweight and on their feet a lot. Heel pain can also occur in children, usually between 8 and 10, as they become increasingly active in sporting activities.
The causes of heel pain
While heel pain has many causes, it is usually the result of faulty biomechanics (abnormalities in the way we walk). This can place too much stress on the heel bone and the soft tissues attached to it.
The stress may also result from injury, or a bruise incurred while walking, running, jumping on hard surfaces; wearing poorly constructed footwear; or being significantly overweight. Systemic diseases such as diabetes and arthritis can also contribute to heel pain.
Common Complications
Heel Spur
A common cause of heel pain is the heel spur, a bony growth under the heel bone. There are no visible features on
the heel, but a deep painful spot can be found in or around the middle of the sole of the heel (see diagram).
Approximately 10% of the population may have heel spurs without any pain.
Heel spurs result from strain on the muscles of the foot. This may result from biomechanical imbalance, a condition occurring in many people.
Plantar Fasciitis
Both heel pain and heel spurs are frequently associated with an inflammation of the long bands of tissue that connects the heel and the ball of the foot. The inflammation of this arch area is called plantar fasciitis.
The plantar fascia is an important support of the medial longitudinal arch and excessive pronation can cause chronic irritation of this structure, usually at its attachment to the calcaneus.
The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle. Pain is normally felt under the inside aspect of the heel. Characteristically this occurs with the first few steps taken on arising in the morning. Walking on the toes or climbing stairs may make the pain worse.
Other causes of heel pain
- Excessive rolling in of the feet when walking.
- An inflamed bursa (bursitis), a small, irritated sack of fluid at the back of the heel.
- A Neuroma (a nerve growth)
- Other soft tissue growths
- Heel bumps or 'pump-bumps', a bone enlargement at the back of the heel bone.
- Bruises or stress fractures to the heel bone.
Overcoming the problem
If pain and other symptoms of inflammation - redness, swelling, heat - persist, you should limit normal daily activities and consult your podiatrist.
Your podiatrist may conduct a number of x-rays to look for heel spurs or fractures.
Treatment
Treatment should be directed towards relief of the pain and inflammation and control of adverse mechanical factors to prevent recurrence. Footwear modification, orthotic control of excessive and/or prolonged pronation, if indicated, stretching tight calf muscles and activity modification should be commenced early. Ice applications and deep massage may assist recovery and a 4-8mm heel raise, perhaps supported by low-dye taping often provides relief.
These treatments will effectively treat the majority of heel and arch pain without the need for surgery. Only a relatively few cases of heel pain require surgery. If required, surgery is usually for the removal of the spur, but also may involve release of the plantar fascia, removal of bursa, or a removal of a neuroma or other soft tissue growth.
Recovery
Your recovery will depend on the cause of your heel pain and your individual health. If you are suffering with a heel spur or plantar fasciitis, it normally takes about six to eight weeks for a healthy individual to fully recover.
Preventing future problems
Footwear
Wear shoes that fit well - front, back and sides - and have shock absorbent soles, rigid uppers and supportive heel counters. Do not wear shoes with excessive wear on heels or soles
Stretches and ExercisePrepare properly before exercising. Warm up before running or walking, and do some stretching exercises afterward.
Pace yourself when you participate in athletic activities. If overweight, try non weight bearing activities such as swimming or cycling.
Additional control
Your podiatrist may also use taping or strapping to provide extra support for your foot. Orthoses (shoe inserts) specifically made to suit your needs may also be prescribed.
