Heel Pain is one of the most common conditions treated by podiatrists. It is often a message that something is in need of medical attention. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we have suffered. Heel pain is a problem which affects people of all ages and vocations, whether they are active or not and it comes in many different forms. Heel pain can also occur in children usually between the ages of 8 and 13, as they become increasingly active in sporting activities and during the growing phase.
There are many causes of heel pain. However, plantar fasciitis, also known as heel spur syndrome, is the most common, by far. The pain is usually localized to the bottom of the heel towards the inside of the foot. The arch may also be painful. With this condition, pain is typically most severe with the first few steps after a period of rest. The pain my then subside and then return after extended periods of standing. There is usually no specific traumatic event that is responsible for the condition. It is usually the result of overuse, e.g. too much standing, walking or running. There are several common contributory factors such as weight gain, foot type, shoes. Flat shoes or going barefoot are the worst. Athletic shoes are usually the best. The plantar fascia is a fibrous band or ligament that connects the ball of the foot with the heel and helps to support the arch. When this band gets stretched too much or overused, inflammation results, often at the location where it attaches to the heel bone. A heel spur may develop as a result of chronic pulling by the plantar fascia. However, it should be noted that the pain is not caused by the spur. In fact, in some of the most severe cases, there is no spur at all. In other instances, an X-ray may be taken for an unrelated condition and an extremely large but non-painful spur may be seen. Other causes of heel pain include gout, stress fracture, bone tumors, nerve entrapment and thinning of the fat pad beneath the heel. Pain at the back of the heel is usually not plantar fasciitis. (Pain at the back of the heel is often due to an inflammation of the Achilles tendon, enlargement of the heel bone or bursitis.)
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).
To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
Non Surgical Treatment
Using our state-of-the-art equipment, Dr. Weinert is able to provide a full work up for the heel, including gait analysis. Digital imagining gives him and the patient a full view of the foot and injury to help formulate the best treatment plan possible. There are numerous treatment options available to help with heel pain and plantar fasciitis. Anti-inflammatory medications. Digital custom orthotics. Physical therapy. Diagnostic and ultrasonic guided injection therapy. No one should ever resign to living with foot pain.
Surgery to correct heel pain is generally only recommended if orthotic treatment has failed. There are some exceptions to this course of treatment and it is up to you and your doctor to determine the most appropriate course of treatment. Following surgical treatment to correct heel pain the patient will generally have to continue the use of orthotics. The surgery does not correct the cause of the heel pain. The surgery will eliminate the pain but the process that caused the pain will continue without the use of orthotics. If orthotics have been prescribed prior to surgery they generally do not have to be remade.
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.