HEEL PAIN

Heel pain has many causes. Most often it is a result of poor foot biomechanics (walking abnormalities) that place too much stress on the heel bones and the soft tissues that attach to it. The pain may also result from injury or a bruise incurred while walking, running, or jumping on hard surfaces or wearing poorly constructed footwear and being overweight.

There are 26 bones in the human foot, the largest being the heel bone (calcaneus). The heel bone is affected by outside influences and may be injured from participating in sports, walking, or spending prolonged periods on the feet.

HEEL SPURS

A heel spur is an excessive bony growth on the underside of the heel bone. A spur, which is visible on x-ray, appears as a protrusion and can extend forward as much as half an inch. Some heel spurs are never painful and are only discovered on routine x-ray examination. The spurs result from strain of the muscles and ligaments of the foot, placing extra stretch on the bone causing the bone to respond with excessive bony growth. While the heel spur itself may not be painful, it usually is associated with inflammation of soft tissue structures that attach to it.

PLANTAR FASCIITIS

On the bottom (plantar) aspect of the foot, there is a broad band of fibrous connective tissue (fascia) which begins at the heel bone (calcaneus) and extends to the ball of the foot. This band of tissue may become inflamed and when it does it is called plantar fasciitis. It is common among people who spend a long time on hard unforgiving surfaces like concrete, tile, or hard wood floors. It is also common in athletes who run and jump.

The plantar fascia is strained over time when forces cause it to stretch beyond its normal limits. The soft tissue fibers of the fascia tear or stretch at points along its length; this leads to inflammation, pain, and possibly a growth of a bone spur where the fascia attaches to the heel bone.

The inflammation may be aggravated by shoes that lack adequate support, especially in the arch area.

Classic signs of plantar fasciitis are pain upon rising from bed in the morning, when taking the first few steps, or pain after prolonged sitting and then rising to get up. This occurs because while at rest, the plantar fascia has a chance to shorten and contract and then with weight bearing on the foot the fascia tries to stretch faster than it can accommodate to. This causes an intense pain that may lessen or even disappear as you begin to walk but usually returns after prolonged rest or extensive walking.

FLATFEET

Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot which allows it to adapt to ground surfaces and absorb shock during walking. Excessive pronation or excessive flattening of the arch can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom of the heel bone. This may also lead to injury to the hip, knee, and low back.

DISEASES ASSOCIATED WITH HEEL PAIN.

  • Rheumatoid arthritis and other forms of arthritis, including gout can cause heel pain.
  • Bursitis, an inflamed soft tissue sac around the heel bone may also cause heel pain.
  • Haglund's deformity also known as a "pump bump" is a bony enlargement at the back of the heel bone where the Achilles tendon attaches to the bone. This often at times painful deformity usually is the result of bursitis caused by pressure against the shoe.
  • Achilles tendonitis is associated with inflammation of the Achilles tendon as it courses behind the ankle and inserts into the back surface of the heel bone. This condition is common among people who run and walk a lot and have a propensity for tight tendons. Over time, the Achilles tendon fibers tear or stretch along its length, or at its insertion into the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone.
  • Bone bruises are common heel injuries. A bone bruise or contusion is an inflammation of the tissues that cover the heel bones. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.

CHILDREN’S HEEL PAIN

Heel pain may occur in children, commonly between ages 8 and 13 years old. During this time, children become increasingly active in sports activities. This physical activity, particularly jumping, inflames the growth centers of the heels. This inflammation of the growth center (epiphysis) causes pain with walking, running and jumping. When the bones mature and the growth centers fuse, the problems disappear. If heel pain occurs in this age group, it is necessary to protect the growing bone and to provide pain relief.

TREATMENT OF HEEL PAIN

If pain or inflammation persists, limited daily activity will help. Dr. Honick will examine your foot and may perform diagnostic x-rays or other specialized tests such as MRIs or bone scans to rule out problems of bone and soft tissues.

Conservative treatment may involve resting the foot or wearing specialized splints, casts, or boots. Treatment may also require oral or injectable anti-inflammatory medications, exercise and shoe recommendations, taping or strapping, or use of custom molded orthotic devices.

A functional orthotic device may be prescribed for correcting biomechanical abnormalities to control excessive pronation and maintaining more neutral foot position.

Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is required, it may involve the partial release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.

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