Understand Heel Pains
Overview
Heel pain is a common symptom that has many possible causes. Although heel pain sometimes is caused by a systemic (body-wide) illness, such as rheumatoid arthritis or gout, it usually is a local condition that affects only the foot.
Causes
There are many possible causes of heel pain. Most commonly it is a chronic, long-term pain that results of some type of faulty biomechanics (abnormalities in the way you walk) that place too much stress on the heel bone and the soft tissues that attach to it. Chronic pain is a common result of standing or walking too many hours in the course of a day, working on concrete, being overweight, wearing poorly-constructed shoes, having an overly-pronated foot type (where the arch collapses excessively) or the opposite--having too high an arch. Women seem to get this slightly more often than men, and while any age can be affected, it usually occurs between 30 and 50 years of age. The other type of heel pain is the sort you get from an acute injury--a bruise to the bone or soft tissue strain resulting from a strenuous activity, like walking, running, or jumping, or from some degree of trauma. While there are dozens of possible causes to heel pain, I will review some of the more common causes. Arch Pain/Plantar Fasciitis. One of those often-painful soft tissue that attaches to heel spurs at the bottom of the foot is called "plantar fascia". Fascia, located throughout the body, is a fibrous connective tissue similar to a ligament. You can see fascia as some of that white, connective tissue attaching to bones, when you pull apart meat. The "plantar" fascia in our bodies is that fascia which is seen on the bottom (or plantar portion) of the foot, extending from the heel bone to the ball of the foot. Compared to other fascia around the body, plantar fascia is very thick and very strong. It has to be strong because of the tremendous amount of force it must endure when you walk, run or jump. But while the plantar fascia is a strong structure, it can still get injured, most commonly when it is stretched beyond its normal length over long periods of time. Plantar Fascitis. When plantar fascia is injured, the condition is called "plantar fasciitis", pronounced "plan-tar fash-I-tis". (Adding "-itis" to the end of a word means that structure is inflamed.) It is sometimes known more simply as 'fasciitis'. Plantar fasciitis is the most common type of arch pain. Symptoms of plantar fasciitis may occur anywhere along the arch, but it is most common near its attachment to the heel bone.
Symptoms
Initially, this pain may only be present when first standing up after sleeping or sitting. As you walk around, the muscle and tendon loosen and the pain goes away. As this problem progresses, the pain can be present with all standing and walking. You may notice a knot or bump on the back of the heel. Swelling may develop. In some cases, pressure from the back of the shoe causes pain.
Diagnosis
Depending on the condition, the cause of heel pain is diagnosed using a number of tests, including medical history, physical examination, including examination of joints and muscles of the foot and leg, X-rays.
Non Surgical Treatment
The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone. Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments. A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery. Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.
Surgical Treatment
When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.
heel cups for heel pain
Prevention
Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising. Wear comfortable, properly fitting shoes with good arch support and cushioning. Make sure there is enough room for your toes.
Heel pain is a common symptom that has many possible causes. Although heel pain sometimes is caused by a systemic (body-wide) illness, such as rheumatoid arthritis or gout, it usually is a local condition that affects only the foot.
Causes
There are many possible causes of heel pain. Most commonly it is a chronic, long-term pain that results of some type of faulty biomechanics (abnormalities in the way you walk) that place too much stress on the heel bone and the soft tissues that attach to it. Chronic pain is a common result of standing or walking too many hours in the course of a day, working on concrete, being overweight, wearing poorly-constructed shoes, having an overly-pronated foot type (where the arch collapses excessively) or the opposite--having too high an arch. Women seem to get this slightly more often than men, and while any age can be affected, it usually occurs between 30 and 50 years of age. The other type of heel pain is the sort you get from an acute injury--a bruise to the bone or soft tissue strain resulting from a strenuous activity, like walking, running, or jumping, or from some degree of trauma. While there are dozens of possible causes to heel pain, I will review some of the more common causes. Arch Pain/Plantar Fasciitis. One of those often-painful soft tissue that attaches to heel spurs at the bottom of the foot is called "plantar fascia". Fascia, located throughout the body, is a fibrous connective tissue similar to a ligament. You can see fascia as some of that white, connective tissue attaching to bones, when you pull apart meat. The "plantar" fascia in our bodies is that fascia which is seen on the bottom (or plantar portion) of the foot, extending from the heel bone to the ball of the foot. Compared to other fascia around the body, plantar fascia is very thick and very strong. It has to be strong because of the tremendous amount of force it must endure when you walk, run or jump. But while the plantar fascia is a strong structure, it can still get injured, most commonly when it is stretched beyond its normal length over long periods of time. Plantar Fascitis. When plantar fascia is injured, the condition is called "plantar fasciitis", pronounced "plan-tar fash-I-tis". (Adding "-itis" to the end of a word means that structure is inflamed.) It is sometimes known more simply as 'fasciitis'. Plantar fasciitis is the most common type of arch pain. Symptoms of plantar fasciitis may occur anywhere along the arch, but it is most common near its attachment to the heel bone.
Symptoms
Initially, this pain may only be present when first standing up after sleeping or sitting. As you walk around, the muscle and tendon loosen and the pain goes away. As this problem progresses, the pain can be present with all standing and walking. You may notice a knot or bump on the back of the heel. Swelling may develop. In some cases, pressure from the back of the shoe causes pain.
Diagnosis
Depending on the condition, the cause of heel pain is diagnosed using a number of tests, including medical history, physical examination, including examination of joints and muscles of the foot and leg, X-rays.
Non Surgical Treatment
The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone. Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments. A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery. Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.
Surgical Treatment
When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.
heel cups for heel pain
Prevention
Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising. Wear comfortable, properly fitting shoes with good arch support and cushioning. Make sure there is enough room for your toes.
