Heel Pain

Overview

Foot Pain

Heel pain is pain in the heel area that can vary in severity and location. It is most common in adults. The heel is the first bone to contact the ground when walking and takes the full force of impact and the resulting shock of bearing weight during motion.

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

Symptoms of plantar fasciitis vary, but the classic symptom is pain after rest--when you first get out of bed in the morning, or when you get up after sitting down for a while during the day. The pain usually diminishes after a few minutes of walking, sometimes even disappearing, but the pain is commonly felt again the longer you're on the foot. Fasciitis can be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation of long-periods of standing, especially on concrete, by being overweight. It doesn't help that fascia doesn't heal particularly quickly because it has relatively poor circulation (which is why it's white in colour).

Diagnosis

A podiatrist (doctor who specializes in the evaluation and treatment of foot diseases) will carry out a physical examination, and ask pertinent questions about the pain. The doctor will also ask the patient how much walking and standing the patient does, what type of footwear is worn, and details of the his/her medical history. Often this is enough to make a diagnosis. Sometimes further diagnostic tests are needed, such as blood tests and imaging scans.

Non Surgical Treatment

Morning Wall Stretch. Stand barefoot in front of wall, as shown. Press into wall with both hands and lean forward, feeling stretch along back of left leg and heel. Hold for 30 seconds; switch sides and repeat. Freeze and Roll. Freeze a small water bottle. Cover it with a towel and place arch of your foot on top of it. Slowly roll bottle beneath arch of foot for about 5 minutes at a time. Switch sides and repeat. Rub It Out. Use both thumbs to apply deep pressure along arch of the feet, heel, and calf muscles, moving slowly and evenly. Continue for 1 minute. Switch sides and repeat. If you foot pain isn't improving or worsens after 2 weeks, a podiatrist or othopedist can prescribe additional therapies to alleviate discomfort and prevent recurrence.

Surgical Treatment

With the advancements in technology and treatments, if you do need to have surgery for the heel, it is very minimal incision that?s done. And the nice thing is your recovery period is short and you should be able to bear weight right after the surgery. This means you can get back to your weekly routine in just a few weeks. Recovery is a lot different than it used to be and a lot of it is because of doing a minimal incision and decreasing trauma to soft tissues, as well as even the bone. So if you need surgery, then your recovery period is pretty quick.

what does a heel spur look like

Prevention

Foot Pain

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.
Remove all ads