Heel Aches

Overview

Foot Pain

Does your heel feel painful when you get up from bed every morning, or when you get up after sitting down for a long period of time? If you often experience this sort of pain, known as ?first step pain?, you could be suffering from plantar fasciitis (pronounced fash-ee-eye-tus), an inflammation of the plantar fascia, or the band of muscle under the foot. Plantar fasciitis is the most common cause of heel pain.

Causes

There are many causes of heel pain. However, plantar fasciitis, also known as heel spur syndrome, is the most common, by far. The pain is usually localized to the bottom of the heel towards the inside of the foot. The arch may also be painful. With this condition, pain is typically most severe with the first few steps after a period of rest. The pain my then subside and then return after extended periods of standing. There is usually no specific traumatic event that is responsible for the condition. It is usually the result of overuse, e.g. too much standing, walking or running. There are several common contributory factors such as weight gain, foot type, shoes. Flat shoes or going barefoot are the worst. Athletic shoes are usually the best. The plantar fascia is a fibrous band or ligament that connects the ball of the foot with the heel and helps to support the arch. When this band gets stretched too much or overused, inflammation results, often at the location where it attaches to the heel bone. A heel spur may develop as a result of chronic pulling by the plantar fascia. However, it should be noted that the pain is not caused by the spur. In fact, in some of the most severe cases, there is no spur at all. In other instances, an X-ray may be taken for an unrelated condition and an extremely large but non-painful spur may be seen. Other causes of heel pain include gout, stress fracture, bone tumors, nerve entrapment and thinning of the fat pad beneath the heel. Pain at the back of the heel is usually not plantar fasciitis. (Pain at the back of the heel is often due to an inflammation of the Achilles tendon, enlargement of the heel bone or bursitis.)

Symptoms

Pain in the heel can be caused by many things. The commonest cause is plantar fascitis. Other causes include, being overweight, constantly being on your feet, especially on a hard surface like concrete and wearing hard-soled footwear, thinning or weakness of the fat pads of the heel, injury to the bones or padding of the heel, arthritis in the ankle or heel (subtalar) joint, irritation of the nerves on the inner or outer sides of the heel, fracture of the heel bone (calcaneum).

Diagnosis

Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray will show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a scan may be used to help spot arthritis or a stress fracture.

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.

Surgical Treatment

It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.

heel cups for achilles tendonitis

Prevention

Heel Discomfort

You should always wear footwear that is appropriate for your environment and day-to-day activities. Wearing high heels when you go out in the evening is unlikely to be harmful. However, wearing them all week at work may damage your feet, particularly if your job involves a lot of walking or standing. Ideally, you should wear shoes with laces and a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels. Do not walk barefoot on hard ground, particularly while on holiday. Many cases of heel pain occur when a person protects their feet for 50 weeks of the year and then suddenly walks barefoot while on holiday. Their feet are not accustomed to the extra pressure, which causes heel pain. If you do a physical activity, such as running or another form of exercise that places additional strain on your feet, you should replace your sports shoes regularly. Most experts recommend that sports shoes should be replaced after you have done about 500 miles in them. It is also a good idea to always stretch after exercising, and to make strength and flexibility training a part of your regular exercise routine.
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