Understand Heel Pain

Overview

Heel Pain is usually focused on the underside or the back of your heel. If your pain is on the underside of your heel, its likely cause is plantar fasciitis. Pain on the back of your heel, where the Achilles tendon attaches to the heel bone, is Achilles tendinitis. Although heel pain is rarely a symptom of a serious condition, it can interfere with your normal activities, particularly exercise.

Causes

While heel pain has many causes, it is usually the result of poor biomechanics (abnormalities in the way we walk). This can place too much stress on the heel bone and the soft tissues attached to it. The stress may result from injury, or a bruise incurred while walking, running or jumping on hard surfaces: wearing poorly constructed footwear : or being significantly over weight. Systemic diseases such as arthritis can also contribute to heel pain.

Symptoms

Pain typically comes on gradually, with no injury to the affected area. It is frequently triggered by wearing a flat shoe, such as flip-flop sandals. Flat footwear may stretch the plantar fascia to such an extent that the area becomes swollen (inflamed). In most cases, the pain is under the foot, toward the front of the heel. Post-static dyskinesia (pain after rest) symptoms tend to be worse just after getting out of bed in the morning, and after a period of rest during the day. After a bit of activity symptoms often improve a bit. However, they may worsen again toward the end of the day.

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

Physical medicine modalities are well known for their benefits and they have been consistently applied in early treatment of plantar fasciitis. Typically, the direct application of ice, ice baths or contrast soaking aid in the local reduction of inflammation and temporarily augment pain management. Electric stimulation may only provide indirect reduction of interstitial inflammation of the plantar fascia. Ultrasound therapy, hot pack systems and deep tissue massage help eliminate inflammation and aid in restoring plantar fascia tensegrity. Generally, these modalities are considered to be valuable adjuncts to a well-organised treatment plan. Various programs of stretching, range of motion and therapeutic exercises can help re-establish foot function and improve tolerance to load. When it is done appropriately, stretching can serve as an important adjunct to the resumption of the plantar fascia?s ability to tolerate eccentric loading forces that typically occur during stance and gait. Night splinting has proven to be an effective tool in managing persistent plantar fasciitis. Antiinflammatory modalities, such as ice and ice baths, are often the first line of treatment. Oral NSAIDs have been a mainstay of treatment. While they effectively relieve symptoms, be aware that they frequently fail to promote sustained relief. When inflammation is severe or fails to respond to initial efforts, one may consider corticosteroid injection(s). However, keep in mind that corticosteroid injections impose the risk of aponeurosis rupture secondary to focal collagen tissue necrosis and can result in focal heel fat pad atrophy.

Surgical Treatment

Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.

Prevention

Heel pain is commonly caused from shoes that do not fit properly. In addition, shoes need to have ample cushioning and support, particularly through the heel, ball of the foot, and arch. Shoes should also be replaced if they become too worn. One sure sign of wear and tear is overly worn areas of a shoe’s insoles. If the heel or ball of the foot is particularly worn, damage could easily occur since the bottom of the foot is not getting the cushioning it needs.

Causes And Treatment Overview For Back Heel Pain

The most common display of faulty foot biomechanics is ‘over-pronation’. Over-pronation is a condition whereby the arches are lowered and the feet and ankles rolling inwards excessively during walking and running. It is believed by podiatrists that over 70% of the population actually suffers from mild to severe over-pronation. Over-pronation should not be confused with flat feet (Pes Planus). Only 5% of the population is flat-footed, i.e. no arch is present whatsoever under the foot. Over-pronators on the other hand do have an arch present, but the arch will lower significantly during walking and running, and the ankles will twist inwards.

This is a condition that occurs in children when there is an injury to the growth plate in the heel of the foot. Because the heel grows faster than other bones of the body, it reaches full size first. According to Family Doctor, during this time the muscles and tendons tighten and the heel becomes less flexible. The tight tendons put pressure on the back of the heel and can cause an injury to the heel. It is most common in physically active girls ages 8 to 10 and physically active boys ages 10 to 12 years. Photo Credit foot image by razorconcept from Fotolia.com.

The Achilles tendon can also become chronically inflamed, known as tendinosis. This condition is sometimes caused by microscopic tears within the tendon or previous partial tears that were not rested and rehabilitated properly. The symptoms are similar to plantar fasciitis in that stiffness and pain is worse in the morning and when beginning activity. Lumps or swelling, along with a burning sensation, are signs that activities should be stopped to avoid further aggravating the condition and possibly creating a rupture. Certain medications, such as oral steroids and a class of antibiotics known as quinolones, increase an individual’s vulnerability of Achilles tendinosis and rupture.

As we get older we tend to put in a bit of extra weight. The combination of weight gain and ageing means we put a lot of extra tension on our muscles and ligaments in the feet, legs and back. Most people tend to over-pronate because of weight gain. Over-pronation (fallen arches) is the main cause of Plantar Fasciitis and heel pain. Therefore by losing weight you will decrease the tension on the plantar fascia. Hope all of the above mentioned information will help you to understand every aspect of heel pain and what type of treatment they are required to get relief from their heel pain and foot pain.

Posterior heel pain causes symptoms behind the foot, rather than underneath. Posterior heel pain causes include Achilles tendonitis and retrocalcaneal bursitis. Learn about causes of posterior heel pain and what treatments are available. When do you need to call your doctor about your heel pain? Treatment of heel pain depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment plan.