Overview
Heel pain may develop when you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues. A sore heel will usually get better on its own if you give it enough rest. Unfortunately, many people try to ignore the early signs of heel pain and keep on doing the activities that caused it and this can lead to chronic pain. Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel. Pain beneath the Heel. If it hurts under your heel, you may have one or more conditions that cause inflammation of the tissues on the bottom of your foot. Stone bruise. By stepping on a hard object, you can bruise the fat pad on the bottom side of your heel. It may or may not look discoloured. With rest, the pain subsides gradually. Causes There are two different categories of heel pain. The first is caused by over-use repetitive stress which refers to a soreness resulting from too much impact on a specific area of the foot. This condition, often referred to as "heel pain syndrome," can be caused by shoes with heels that are too low, a thinned out fat pad in the heel area, or from a sudden increase in activity. Plantar fasciitis, a very common diagnosis of heel pain, is usually caused from a biomechancial problem, such as over-pronation (flat feet). The plantar fascia is a broad band of fibrous tissue that runs along the bottom surface of the foot, from the heel through the midfoot and into the forefoot. Over-pronation can cause the plantar fascia to be excessively stretched and inflamed, resulting in pain in the heel and arch areas of the foot. Often the pain will be most intense first thing in the morning or after a prolonged period of rest. The pain will gradually subside as the day progresses. Symptoms Sever?s Disease. This is a condition that occurs in 10 - 15 year old children, predominantly boys and is associated with running and repetitive jumping. It is also associated with flimsy footwear that kids may wear. It occurs when the Achilles tendon continually pulls on the apophysis of the calcaneum and does not allow for it to fuse with the body of the calcaneum. Calcaneal enthesopathy. This occurs when there is repetitive trauma at the attachment of the Achilles tendon, resulting in a spur from the calcaneum up into the Achilles tendon. It is usually visualized on x-ray and may be tender if there is an associated bursitis or tendonitis. "Pump Bump". Also known as Haglund?s Deformity, this is a bony enlargement that exists on the back of the heel - usually related to a congenital abnormality or with chronic bursitis, causing a thickening. There may have already been trauma or pressure from footwear. Treatment is usually protection of the bump and correct footwear. Associated with a symmetrical swelling at the base of the Achilles tendon. It is usually related to repetitive trauma or inappropriate footwear. It is often red and hot in the early stages. Treatment is usually to correct the footwear, provide padding and treat the local symptoms e.g. ice, rest, physiotherapy and cortisone injection. Fat Pad Syndrome. Direct contact with the base of the heel may result in trauma to the fat pad. Related to obesity, training on hard surfaces, uneven grounds, poor shoes especially overlarge shoes which can cause shearing forces on the heel. These conditions are renowned for taking a long time to recover - usually many months. Diagnosis To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome. Non Surgical Treatment Treatment of heel pain generally occurs in stages. At the earliest sign of heel pain, aggressive calf muscle stretching should be started. Additionally, taking an oral anti-inflammatory medication and over-the- counter arch supports or heel cushions may be beneficial. The next phase of treatment might consist of continued calf muscle stretching exercises, cortisone injections and orthopedic taping of the foot to support the arch. If this treatment fails, or if there is reoccurrence of the heel pain, then functional foot orthotics might be considered. A functional orthotic is a device that is prescribed and fitted by your foot doctor, which fits in normal shoes like an arch support. Unlike an arch support, however the orthotic corrects abnormal pronation of the subtalar joint. Thus orthotics address the cause of the heel pain - abnormal pronation of the foot. Pump bump, treatment is similar to the treatment of bursitis and heel spurs. In rare cases, the bony growth at the heel may need to be removed surgically. Heel bruises can be treated by applying an ice pack for the first few minutes after injury. Achilles tendonitis, this condition is treated conservatively with rest, NSAIDs and physical therapy. If a sprain, fracture or other injury has caused the trapped nerve, this underlying problem must be treated first. In rare cases, surgery may be done to release the trapped nerve. Surgical Treatment Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a "numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment). heel spur exercises Prevention Wear properly fitting shoes. Place insoles or inserts in your shoes to help control abnormal foot motion. Maintain a healthy weight. Exercise and do foot stretches as they have been shown to decrease the incidence of heel pain.
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July 2017
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