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kristiecapria

Heel Pain

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Heel Discomfort

Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst. Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is able to distinguish between all the possibilities and determine the underlying source of your heel pain. Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.

Causes

To understand the cause of the pain one must understand the anatomy of the foot and some basic mechanics in the function of the foot. A thick ligament, called the plantar fascia, is attached into the bottom of the heel and fans out into the ball of the foot, attaching into the base of the toes. The plantar fascia is made of dense, fibrous connective tissue that will stretch very little. It acts something like a shock absorber. As the foot impacts the ground with each step, it flattens out lengthening the foot. This action pulls on the plantar fascia, which stretches slightly. When the heel comes off the ground the tension on the ligament is released. Anything that causes the foot to flatten excessively will cause the plantar fascia to stretch greater that it is accustom to doing. One consequence of this is the development of small tears where the ligament attaches into the heel bone. When these small tears occur, a very small amount of bleeding occurs and the tension of the plantar fascia on the heel bone produces a spur on the bottom of the heel to form. Pain experienced in the bottom of the heel is not produced by the presence of the spur. The pain is due to excessive tension of the plantar fascia as it tears from its attachment into the heel bone. Heel spur formation is secondary to the excessive pull of the plantar fascia where it attaches to the heel bone. Many people have heel spurs at the attachment of the plantar fascia with out having any symptoms or pain. There are some less common causes of heel pain but they are relatively uncommon. There are several factors that cause the foot to flatten and excessively stretching the plantar fascia. The primary factor is the structure of a joint complex below the ankle joint, called the subtalar joint. The movement of this joint complex causes the arch of the foot to flatten and to heighten. Flattening of the arch of the foot is termed pronation and heightening of the arch is called supination. If there is excessive pronation of the foot during walking and standing, the plantar fascia is strained. Over time, this will cause a weakening of the ligament where it attaches into the heel bone, causing pain. When a person is at rest and off of their feet, the plantar fascia attempts to mend itself. Then, with the first few steps the fascia re-tears causing pain. Generally, after the first few steps the pain diminishes. This is why the heel pain tends to be worse the first few steps in the morning or after rest. Another factor that contributes to the flattening of the arch of the foot is tightness of the calf muscles. The calf muscle attaches into the foot by the achilles tendon into the back of the heel. When the calf muscle is tight it limits the movement of the ankle joint. When ankle joint motion is limited by the tightness of the calf muscle it forces the subtalar joint to pronate excessively. Excessive subtalar joint pronation can cause several different problems to occur in the foot. In this instance, it results in excessive tension of the plantar fascia. Tightness of the calf muscles can be a result of several different factors. Exercise, such as walking or jogging will cause the calf muscle to tighten. Inactivity or prolonged rest will also cause the calf muscle to tighten. Women who wear high heels and men who wear western style cowboy boots will, over time, develop tightness in the calf muscles.

Symptoms

Usually worse with the first few steps in the morning or at the initial point of activity. The latter usually gets better with continued activity (squeaky hinge analogy). Walking, running, sprinting, hill running and jumping will increase the pain. Often, the natural response is to walk on the outside of the foot - in supination - to lessen the stress on the plantar fascia - resulting in new problems.

Diagnosis

The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.

Non Surgical Treatment

If you develop heel pain, you can try several methods at home to ease your discomfort. For example rest as much as possible, apply ice to the heel for 10 to 15 minutes twice a day, use over-the-counter pain medications, wear shoes that fit properly, wear night splints, a special device that stretches the foot while you sleep, use heel cups or shoe inserts to reduce pain, If these home care strategies do not ease your pain, you will need to see your doctor. He or she will perform a physical exam and ask you about your symptoms and when they began. Your doctor may also take an X-ray to determine the cause of your heel pain. Once your doctor knows what is causing your pain, he or she will be able to provide you with the appropriate treatment. In many cases, your doctor may prescribe physical therapy. This can help to strengthen the muscles and tendons in your foot, which helps to prevent further injury. If your pain is severe, your doctor may provide you with anti-inflammatory medications. These medications can be injected into the foot or taken by mouth. Your doctor may also recommend that you support your foot as much as possible-either by taping the foot or by using special footwear devices. In very rare cases, your doctor may recommend surgery to correct the problem. However, heel surgery often requires a long recovery time and may not always relieve your foot pain.

Surgical Treatment

Only a relatively few cases of heel pain require surgery. If required, surgery is usually for the removal of a spur, but also may involve release of the plantar fascia, removal of a bursa, or a removal of a neuroma or other soft-tissue growth.

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Prevention

Painful Heel

Wearing real good, supportive shoes are a great way to avoid heel pain. Usually, New Balance is a good shoe to wear, just for everyday shoe gear. By wearing proper footwear and performing thorough stretches, athletes can help prevent frequent heel pain. If you are starting to get a little discomfort or pain in the feet or heel, know that pain is not normal. So if you are having pain, you should be proactive and visit our office. If you let heel pain get out of control you could run into several other problems. It is always suggested to visit a podiatrist whenever you are experiencing pain.

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