Heel pain is most often caused by plantar fasciitis—a condition that’s 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’s important to have heel pain properly diagnosed. A foot and ankle surgeon is best trained to distinguish between all the possibilities and determine the underlying source of your heel pain. Long story short, 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.
Treatment of Heel Pain
Treatment of plantar fasciitis begins with first-line strategies that you can begin at home:
- Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
- Ice. Putting an ice pack on your heel for 10 minutes several times a day helps reduce inflammation.
- Limit activities. Cut down on extended physical activities to give your heel a rest.
- Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia. Your shoes should provide a comfortable environment for the foot.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help reduce pain and inflammation.
- Lose weight. Extra pounds put extra stress on your plantar fascia.
- Shoes prerequisites. Wear shoes that fit well—front, back and sides—and have shock-absorbent soles, rigid shanks and supportive heel counters. Also, wear the proper shoes for each activity. Don’t wear shoes with excessive wear on heels or soles. If you have experienced painful heels, try wearing your shoes around your house in the evening. Don’t wear slippers or socks or go barefoot.
- Prepare properly before exercising. Warm up and do stretching exercises before and after running.
- Pacing. Pace yourself when you participate in athletic activities.
- Resting and nutrition. Don’t underestimate your body’s need for rest and good nutrition.
If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these approaches:
- Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
- Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
- Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
- Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
- Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
- Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
- When to contact the doctor. If the pain persists longer than one month, you should visit a podiatrist for evaluation and treatment. Your feet should not hurt, and professional podiatric care may be required to help relieve your discomfort.
- Exercise precautions. If you have not exercised in a long time, consult your podiatric physician before starting a new exercise program. Also, begin an exercise program slowly. Don’t go too far or too fast.
- Shoe replacement. Purchase and maintain good shoes and replace them regularly.
- Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery. You may also try gentle calf stretches for 20 to 30 seconds on each leg. This is best done barefoot, leaning forward towards a wall with one foot forward and one foot back.
- Walking on surfaces. Avoid uneven walking surfaces or stepping on rocks as much as possible. Moreover, avoid going barefoot on hard surfaces.
- Treadmill tips. Vary the incline on a treadmill during exercise. Nobody walks uphill all the time.
- Listen to your pain. If it hurts, stop. Don’t try to “work through the pain.”
- Surgery. Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.
Causes of Heel Pain
In the pursuit of healthy bodies, pain can be an enemy. In some instances, however, it’s of biological benefit. Pain that occurs right after an injury or early in an illness may play a protective role, often warning people about the damage they’ve suffered. When they sprain an ankle, for example, the pain warns them that the ligament and soft tissues may be frayed and bruised, and that further activity may cause additional injury. Pain also alerts sufferers to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain.
Heel Pain: Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running or jumping on hard surfaces, wearing poorly constructed footwear or being overweight.
The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles and ligaments. Like all bones, it’s subject to outside influences that can affect its integrity and its ability to keep you on our feet. Heel pain, sometimes disabling, can occur in the front, back or bottom of the heel.
Heel Spurs: A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as “heel spur syndrome.”
Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes or obesity.
Plantar Fasciitis: Both heel pain and heel spurs are frequently associated with an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation is called plantar fasciitis. It’s common among athletes who run and jump a lot, and it can be quite painful.
The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain and possibly the growth of a bone spur where it attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.
Resting provides only temporary relief. When you resume walking, particularly after a night’s sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.
Excessive Pronation: Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.
As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee and lower back.
No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. If you’re overweight, it’s important to reach and maintain an ideal weight. For all patients, wearing supportive shoes and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
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