Heel pain accounts for one of the most common types of pain felt in the foot. Pain in the heel of the foot can be caused as a result of exercise, daily work routines or recreational activities. Some
type of repetitive stress on the foot is often at the root of Heel Pain
. The largest bone in the foot
is the calcaneus, or heel bone. When we walk, the heel bone is usually the first part of the foot that hits the ground and is responsible for supporting much of the body's weight. This makes the heel
of the foot prone to injury.
Both heel pain and heel spurs are frequently associated with an inflammation of the long band of tissue that connects the heel and the ball of the foot. The inflammation of this arch area is called
plantar fasciitis. The inflammation maybe aggravated by shoes that lack appropriate support and by the chronic irritation that sometimes accompanies an athletic lifestyle. Achilles Tendinopathy, Pain
and inflammation of the tendon at the back of the heel that connects the calf muscle to the foot. Sever?s, Often found in children between the ages of 8 - 13 years and is an inflammation of the
calcaneal epiphyseal plate (growth plate) in the back of the heel. Bursitis. An inflamed bursa is a small irritated sack of fluid at the back of the heel. Other types of heel pain include soft tissue
growths, Haglunds deformity (bone enlargement at the back of the heel), bruises or stress fractures and possible nerve entrapment.
Depending on the specific form of heel pain, symptoms may vary. Pain stemming from plantar fasciitis or heel spurs is particularly acute following periods of rest, whether it is after getting out of
bed in the morning, or getting up after a long period of sitting. In many cases, pain subsides during activity as injured tissue adjusts to damage, but can return again with prolonged activity or
when excessive pressure is applied to the affected area. Extended periods of activity and/or strain of the foot can increase pain and inflammation in the foot. In addition to pain, heel conditions
can also generate swelling, bruising, and redness. The foot may also be hot to the touch, experience tingling, or numbness depending on the condition.
Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You
will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot - this could
be a sign of nerve damage in your feet and legs (peripheral neuropathy), your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone
infection, you have stiffness and swelling in your heel - this could be a sign of arthritis. Possible further tests may include, blood tests, X-rays - where small doses of radiation are used to
detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.
Non Surgical Treatment
The proper treatment for your heel pain depends entirely on the specific cause(s) of your symptoms. Therefore, it is critical to understand the cause(s) of your symptoms before beginning any
treatment program and if you are unsure, then seeking medical advice is essential to develop the proper treatment program for your condition. Some common treatments are listed and can be performed at
home. Keep in mind that not all of these treatments are appropriate for every condition, but they usually a good place to start. Rest, reducing activities for a few days can help to reduce the most
severe pain. Ice, applying ice to the heel for 10 minutes several times a day will help to reduce inflammation. Stretching exercises, to lengthen the muscles in the back of the leg, including the
hamstrings, will help to ease pain, reduce focal pressures to your feet and assist in recovery. For plantar fasciitis, this may be the best treatment of all. Avoid going barefoot, when without shoes
excessive stress and strain is placed on the plantar fascia. Proper shoe gear, supportive shoes that fit and are not too worn along with good arch support help to reduce the stress and strain on the
plantar fascia over time. Medications, non-steroidal anti-inflammatory medication, such as Motrin (ibuprofen), may help to reduce inflammation. If the pain persists or worsens after a couple of days,
an appointment may be necessary where Dr. Talarico may add one or more of these additional modalities to your treatment program. Orthotic b, whether pre-fabricated or custom orthotic is used, these
devices can help reduce the underlying structural abnormalities of the foot which have lead to the development of plantar fasciitis. These are often used to limit the recurrence of plantar fasciitis
pain. Strapping, a special taping technique to help reduce the strain on the fascia. Injection therapy, in some instances injections are used to reduce the inflammation and reduce pain. Night Splint,
this allows you to maintain an extended stretch on the plantar fascia while sleeping. Over time, this has shown to reduce the morning pain which some people experience. Removable Walking Cast, in
some case of severe heel pain this may be used to keep your foot immobile for a few weeks allowing it to rest and heal. Physical Therapy may be recommended to aid in pain relief. At The Foot &
Ankle Center, PC, Dr Talarico will often utilize two additional in-office modalities, EPAT and MLS Laser Therapy, which are very effective in treating most inflammatory conditions of the foot and
ankle, including plantar fasciitis.
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).
The following steps will help prevent plantar fasciitis or help keep the condition from getting worse if you already have it. The primary treatment is rest. Cold packs application to the area for 20
minutes several times a day or after activities give some relief. Over-the-counter pain medications can help manage the pain, consult your healthcare professional. Shoes should be well cushioned,
especially in the midsole area, and should have the appropriate arch support. Some will benefit from an orthotic shoe insert, such as a rubber heel pad for cushioning. Orthotics should be used in
both shoes, even if only one foot hurts. Going barefoot or wearing slipper puts stress on your feet. Put on supportive shoes as soon as you get out of bed. Calf stretches and stretches using a towel
(place the towel under the ball of your feet and pull gently the towel toward you and hold a few seconds) several times a day, especially when first getting up in the morning. Stretching the Achilles
tendon at the back of the heel is especially important before sports, but it is helpful for nonathletes as well. Increasing your exercise levels gradually. Staying at a healthy weight. Surgery is
very rarely required.