Heel Pain
Definition
Heel pain is a common foot problem. The pain usually occurs underneath your heel (plantar fasciitis) or just behind it, where the Achilles tendon attaches to the heel bone (Achilles tendinitis). Although the cause of heel pain often isn’t serious, the pain itself can be severe and occasionally disabling.
Causes
It is unusual for heel pain to be present in both heels simultaneously in the absence of trauma, with the left heel the most commonly affected. However when one heel is painful, the walking gait is altered putting an increased strain on the opposite heel, which can also become affected as the body compensates and shifts the weight distribution.
The exact location and nature of the pain are two of the key indicators of the underlying problem. Heel pain is medically classified as posterior heel pain and inferior heel pain. Posterior heel pain is felt at the rear of the foot and is less common than inferior heel pain, when the pain is felt directly underneath the heel.
The most common causes of heel pain are:
• Plantar fasciitis (plantar fasciosis) – inflammation of the plantar fascia. The plantar fascia is a strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot. When the plantar fasciitis is stretched too far its soft tissue fibers become inflamed, usually where it attaches to the heel bone. Sometimes the problem may occur in the middle of the foot. The patient experiences pain under the foot, especially after long periods of rest. Some patients have calf-muscle cramps if the Achilles tendon tightens too.
• Heel bursitis – inflammation of the back of the heel, the bursa (a fibrous sac full of fluid). Can be caused by landing awkwardly or hard on the heels. Can also be caused by pressure from footwear. Pain is typically felt either deep inside the heel or at the back of the heel. Sometimes the Achilles tendon may swell. As the day progresses the pain usually gets worse.
• Heel bumps (pump bumps) – common in teenagers. The heel boneis not yet fully mature and rubs excessively, resulting in the formation of too much bone. Often caused by having a flat foot. Among females can be caused by starting to wear high heels before the bone is fully mature.
• Tarsal tunnel syndrome – a large nerve in the back of the foot becomes pinched, or entrapped (compressed). This is a type of compression neuropathy that can occur either in the ankle or foot.
• Chronic inflammation of the heel pad – caused either by the heel pad becoming too thin, or heavy footsteps.
• Stress fracture – this is a fracture caused by repetitive stress, commonly caused by strenuous exercise, sports, or heavy manual work. Runners are particularly prone to stress fracture in the metatarsal bones of the foot. Can also be caused by osteoporosis.
• Severs disease (calcaneal apophysitis) – the most common cause of heel pain in child/teenage athletes, caused by overuse and repetitive microtrauma of the growth plates of the calcaneus (heel bone). Children aged from 7-15 are most commonly affected.
• Achilles tendonosis (degenerative tendinopathy) – also referred to as tendonitis, tendinosis, and tendinopathy. A chronic (long-term) condition associated with the progressive degeneration of the Achilles tendon. Sometimes the Achilles tendon does not function properly because of multiple, minor microscopic tears of the tendon, which cannot heal and repair itself correctly – the Achilles tendon receives more tension than it can cope with and microscopic tears develop. Eventually, the tendon thickens, weakens, and becomes painful.
Treatment and Prevention
To properly treat heel pain, you must absorb shock, provide cushioning and elevate the heel to transfer pressure. This can be accomplished with a heel cup, visco heel cradle, or an orthotic designed with materials that will absorb shock and shear forces.
When the condition is pronation related (usually plantar fasciitis), an orthotic with medial posting and good arch support will control the pronation, and prevent the inflammation of the plantar fascia.
Footwear selection is also an important criteria when treating heel pain. Shoes with a firm heel counter, good arch support, and appropriate heel height will be the ideal choice.
Heel pain is difficult to cure and often takes months to subside, but most cases can be resolved using conservative treatment methods.
Conservative treatment includes the following:
• Avoiding activities that worsen the condition (e.g., prolonged standing, strenuous exercise)
• Applying ice to the area to reduce pain and inflammation
• Wearing well-cushioned shoes that fit properly
Orthotics and shoe inserts can provide proper support, correct misalignments and imbalances in the foot, and alleviate pressure on heel spurs. Anti-inflammatory medications such as ibuprofen may be used to reduce pain and inflammation. Physical therapy also may be used to relieve heel pain.
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