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Pain, such as may occur in our heels, also alerts us 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 is
subject to outside influences that can affect its
integrity and its ability to keep us 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 is common among athletes who run and jump a lot, and
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.
Disease and Heel Pain
Some general health conditions can also bring about
heel pain.
- Rheumatoid
arthritis and other forms of arthritis, including
gout, which usually manifests itself in the big toe
joint, can cause heel discomfort in some cases.
- Heel pain may
also be the result of an inflamed bursa (bursitis), a
small, irritated sack of fluid; a neuroma (a nerve
growth); or other soft-tissue growth. Such heel pain may
be associated with a heel spur, or may mimic the pain of
a heel spur.
- Haglund's deformity
("pump bump") is a bone enlargement at the back of the
heel bone, in the area where the Achilles tendon
attaches to the bone. This sometimes painful deformity
generally is the result of bursitis caused by pressure
against the shoe, and can be aggravated by the height or
stitchng of a heel counter of a particular shoe.
- Pain at the back of
the heel is associated with inflammation of the achilles
tendon as it runs behind the ankle and inserts on the
back surface of the heel bone. The inflammation is
called achilles tendonitis. It is common among people
who run and walk a lot and have tight tendons. The
condition occurs when the tendon is strained over time,
causing the fibers to tear or stretch along its length,
or at its insertion on to the heel bone. This leads to
inflammation, pain, and the possible growth of a bone
spur on the back of the heel bone. The inflammation is
aggravated by the chronic irritation that sometimes
accompanies an active lifestyle and certain activities
that strain an already tight tendon.
- Bone bruises
are common heel injuries. A bone bruise or contusion is
an inflammation of the tissues that cover the heel bone.
A bone bruise is a sharply painful injury caused by the
direct impact of a hard object or surface on the foot.
- Stress fractures
of the heel bone also can occur, but these are less
frequent.
Children’s Heel Pain
Heel pain can also occur in children, most commonly
between ages 8 and 13, as they become increasingly active
in sports activity in and out of school. This physical
activity, particularly jumping, inflames the growth
centers of the heels; the more active the child, the more
likely the condition will occur. When the bones mature,
the problems disappear and are not likely to recur. If
heel pain occurs in this age group, podiatric care is
necessary to protect the growing bone and to provide pain
relief. Other good news is that heel spurs do not often
develop in children.
Prevention
A variety of steps can be taken to avoid heel pain and
accompanying afflictions:
- Wear shoes that fit
well — front, back, and sides — and have
shock-absorbent soles, rigid shanks, and supportive
heel counters.
- Wear the proper
shoes for each activity.
- Do not wear shoes
with excessive wear on heels or soles.
- Prepare properly
before exercising. Warm up and do stretching exercises
before and after running.
- Pace yourself when
you participate in athletic activities.
- Don’t underestimate
your body's need for rest and good nutrition.
- If obese, lose
weight.
Podiatric Medical Care
If pain and other symptoms of inflammation—redness,
swelling, heat—persist, you should limit normal daily
activities and contact a doctor of podiatric medicine.
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 of 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.
Heel Pain Tips
- If you have
experienced painful heels try wearing your shoes
around your house in the evening. Don't wear
slippers, socks or go barefoot. 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.
- If the pain
persists longer then one month you should visit a
podiatrist for evaluation and treatment. Your feet
should not hurt and it may require professional
podiatric care to help relieve your discomfort.
- If you have not
exercised in a long time, consult your podiatric
physician before starting a new exercise program.
- Begin an exercise
program slowly, don't go too far or too fast.
- Purchase and
maintain good shoes and replace them regularly.
- Stretch each foot
and achilles tendon before and after exercise.
- Avoid uneven
walking surfaces or stepping on rocks as much as
possible.
- Avoid going
barefoot on hard surfaces.
- Vary the incline
on a treadmill during exercise. Nobody walks uphill
all the time.
- If it hurts, stop.
Don't try to "work through the pain."
Your podiatric
physician/surgeon has been trained specifically and
extensively in the diagnosis and treatment of all manners
of foot conditions. This training encompasses all of the
intricately related systems and structures of the foot and
lower leg including neurological, circulatory, skin, and
the musculoskeletal system, which includes bones, joints,
ligaments, tendons, muscles, and nerves. |
In our pursuit of healthy
bodies, pain can be an enemy. In some instances, however,
it is of biological benefit. Pain that occurs right after
an injury or early in an illness may play a protective
role, often warning us about the damage we've suffered.
