Heel Pain

Understanding the Cause of Heel Pain and Do’s & Don’t of self-treatment.

Have you ever wonder why you are experiencing heel pain? Do you get that intense sharp pain in your heel first step in the morning? Does your heel hurt so much that it causes you to stop whatever you are doing? Are you seeking help to solve the pain in your heel?

Heel pain is never normal and it is not something that tends to go away over a period of time. Heel pain is one of the most common conditions treated by podiatrists. It is often a message from the body that something is in need of medical attention.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.

Who Gets Heel Pain?

The greatest incidence of heel pain is seen in middle-aged men and women. It is also seen in those who partake in regular sporting activities and those significantly overweight and on their feet a lot. Heel pain can also occur in children (Learn more about children foot condition – Sever’s disease).

What Can Potentially Be Wrong With My Feet?

A proper diagnosis and effective treatment can be achieved with the help of a podiatrist. Left untreated, heel pain will persist for a long time and may lead to more serious foot complications. There are many forms of heel pain, simply googling your symptoms may not be able to help you identify the exact cause of your heel pain. Only through a detailed assessment, an accurate diagnosis and personalized effective treatment can be made.

Plantar Fasciitis

Plantar fasciitis is by far the most common cause of heel pain. It appears as a strain or even a partial rupture of the sturdy ligament (plantar fascia) which runs from the heel to the ball of the foot which supports the arch of the foot. It is often caused by a combination of tightness in the foot and lower leg muscles and over-pronation.

Symptoms

The main symptom of plantar fasciitis is heel pain when you walk. You may also feel pain when you stand and possibly even when you are resting. This pain is typically most intense with the first step in the morning after you get out of bed or after rest. The pain occurs because you are stretching the plantar fascia. The pain usually lessens with more walking, but you may have it again after periods of rest. You may feel no pain when you are sleeping because the position of your feet during rest allows the fascia to shorten and relax. The pain can be sharp, burning or an ache. In some cases, mild swelling in the heel is present. Heel pain often worsens after long-lasting activities like going for long walks, playing tennis or golf, as well as walking and standing on concrete floors for long periods of time.

Heel Spurs

Another possible cause of heel pain is the heel spur which is a bony growth on the underside and, or back of the heel bone that can develop over a long period of time. The myth of all heel pain is caused by a heel spur is untrue as the majority of the population may have heel spurs without any pain. A heel spur is often referred as a “side-effect” following the continuous pulling of the plantar fascia at the heel bone, causing the body to eventually “respond” by developing a bony growth on the heel bone. It is usually an outcome of prolonged plantar fasciitis or Achilles tendinopathy. As the spur is not the true cause of plantar fasciitis, the pain can be treated without removing the spur in the early stage.

Other Common Causes Of Heel Pain

Some general health conditions can also bring about heel pain. These include:

Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint and can cause heel discomfort in some cases.
An inflamed bursa (bursitis), a small, irritated sack of fluid; a nerve growth (neuroma) or other soft tissue growth.
Fat pad syndrome - reduction in the fatty pad that cushions and protects the heel bone, commonly associated with elderly due to long-term wear and tear on the feet.
Haglund deformity (pump bump) - a bone enlargement at the back of the heel bone. It is often a result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe.
Bone bruises or stress fracture to the heel pain.

What Can I Do For My Heel Pain?

Before seeking help from a doctor or podiatrist, there is a lot you can do yourself to alleviate the pain of heel pain.

Avoid any barefoot walking, especially after getting out of bed in the morning, wear appropriate supportive footwear
Rest, reduced activity: avoid long walks, sports and standing on hard surfaces for long periods
Ice: apply an ice pack onto the heel for 5-10 minutes about 3 or 4 times a day
Compression: a heel splint can be essential to prevent excessive inflammatory oedema
Reduce the inflammation with anti-inflammatory medication and/or a gel or cream
Exercises: do a number of specific exercises to increase flexibility in your feet and legs (link to exercise)

A podiatrist can provide the following treatments should your symptoms persist.

Tapping or strapping: helps to support the foot, placing stressed muscles in a restful state and preventing stretching of the plantar fascia.
Dry needling: to relieve muscle tightness, aids in muscle recovery.
Orthotic insoles: to support the arch of the foot and address any biomechanical issue causing the heel pain. There are different types of orthotics on the market, including gel pads, cushioning rubber insoles etc. In order to effectively treat the cause of heel pain, cushioning under the heel is not enough. It is important to support the arches and realign the foot to its natural position. Your podiatrist will assist you in selecting the best orthotics according to your condition.

In some cases, cortisone-steroid injections may be indicated to target the inflammation. This may work well for some people but it is not a long-term solution. Research has shown that long-term relief can be achieved by treating the root cause of heel pain with a combination of exercises, dry needling, and orthotic therapy.

Only a relatively few cases of heel pain will require surgery. If required, surgery is usually for the removal of a spur, but may also involve the release of the plantar fascia, removal of the bursa, or a removal of a neuroma or other soft-tissue growth. Any foot problem, including heel pain, if detected earlier or prevented is always the best solution.

How Do I Prevent Heel Pain?

A variety of steps can be taken to avoid heel pain.

Wear shoes that are supportive, well fitted and suited to activities.
Do not wear shoes with excessive wear on heels or soles. Get new footwear before your current footwear stop supporting and cushioning your feet.
Prepare properly before exercising. Warm up and do stretching exercises before and after running.
Pace yourself when you participate in athletic activities. Gradual increase in exercise intensity.
Don’t underestimate your body’s need for rest and good nutrition.
Maintain a healthy weight.