What Can Cause Heel Pain

Heel Pain

Overview

Heel Discomfort

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.

Causes

Heel pain is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel. The most common causes of heel pain are Plantar fasciitis (plantar fasciosis) – inflammation of the plantar fascia. The plantar fascia is a strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot. When the plantar fasciitis is stretched too far its soft tissue fibers become inflamed, usually where it attaches to the heel bone. Sometimes the problem may occur in the middle of the foot. The patient experiences pain under the foot, especially after long periods of rest. Some patients have calf-muscle cramps if the Achilles tendon tightens too. Heel bursitis, inflammation of the back of the heel, the bursa (a fibrous sac full of fluid). Can be caused by landing awkwardly or hard on the heels. Can also be caused by pressure from footwear. Pain is typically felt either deep inside the heel or at the back of the heel. Sometimes the Achilles tendon may swell. As the day progresses the pain usually gets worse. Heel bumps (pump bumps) common in teenagers. The heel bone is not yet fully mature and rubs excessively, resulting in the formation of too much bone. Often caused by having a flat foot. Among females can be caused by starting to wear high heels before the bone is fully mature Tarsal tunnel syndrome, a large nerve in the back of the foot becomes pinched, or entrapped (compressed). This is a type of compression neuropathy that can occur either in the ankle or foot. Chronic inflammation of the heel pad, caused either by the heel pad becoming too thin, or heavy footsteps. Stress fracture, this is a fracture caused by repetitive stress, commonly caused by strenuous exercise, sports or heavy manual work. Runners are particularly prone to stress fracture in the metatarsal bones of the foot. Can also be caused by osteoporosis. Severs disease (calcaneal apophysitis) the most common cause of heel pain in child/teenage athletes, caused by overuse and repetitive microtrauma of the growth plates of the calcaneus (heel bone). Children aged from 7-15 are most commonly affected. Achilles tendonosis (degenerative tendinopathy) also referred to as tendonitis, tendinosis and tendinopathy. A chronic (long-term) condition associated with the progressive degeneration of the Achilles tendon. Sometimes the Achilles tendon does not function properly because of multiple, minor microscopic tears of the tendon, which cannot heal and repair itself correctly, the Achilles tendon receives more tension than it can cope with and microscopic tears develop. Eventually, the tendon thickens, weakens and becomes painful.

Symptoms

The symptoms of plantar fasciitis are pain on the bottom of the heel, pain in the arch of the foot, pain that is usually worse upon arising, pain that increases over a period of months. People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they?ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.

Diagnosis

The diagnosis of plantar fasciitis is generally made during the history and physical examination. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions. Pain can be referred to the heel and foot from other areas of the body such as the low back, hip, knee, and/or ankle. Special tests to challenge these areas are performed to help confirm the problem is truly coming from the plantar fascia. An X-ray may be ordered to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to cause problems. Other helpful imaging studies include bone scans, MRI, and ultrasound. Ultrasonographic exam may be favored as it is quick, less expensive, and does not expose you to radiation. Laboratory investigation may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter’s syndrome, or ankylosing spondylitis. These are diseases that affect the entire body but may show up at first as pain in the heel.

Non Surgical Treatment

Depending on the underlying cause, treatment can include. Rest from activities that stress the heel (such as running and jumping). Ice packs. Regular foot massage, concentrating on the arch of the foot. Professional strapping. A splint worn at night. Flexibility exercises. Ultrasound therapy. Anti-inflammatory medicine (topical or oral). Checking your posture and walking style, to correct imbalances and gait abnormalities that may contribute to the pain. Shoe inserts (orthoses) to help support the foot. In some cases, surgery may be recommended to treat conditions including neuroma, bursitis and heel spurs.

Surgical Treatment

It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.

Prevention

Feet Pain

Wear shoes that fit well, front, back and sides and have shock-absorbent soles, rigid uppers and supportive heel counters. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm-up before running or walking, and do some stretching exercises afterward. Pace yourself when you participate in athletic activities. If overweight, try non weight-bearing activities such as swimming or cycling. Your podiatrist may also use taping or strapping to provide extra support for your foot. Orthoses (shoe inserts) specifically made to suit your needs may be also be prescribed.

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What Is Heel Pain And Tips To Heal It

Plantar Fasciitis

Plantar Fascitis

Overview

Plantar fasciitis is a painful inflammatory process of the plantar fascia, a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the five toes. Pain in the arch or heel often indicates inflammation of the long band of tissue under the foot (the plantar fascia). It can cause sharp pain and discomfort in either the mid arch region or at the inside heel, and less commonly the outside heel. It frequently causes pain upon rising from rest (especially first thing in the morning) and can progress to agony by the end of the day. Although plantar fasciitis is the most common cause of this pain, it must be skilfully differentially diagnosed from other conditions via a thorough history taking and physical examination.


Causes

Inappropriate footwear is the No. 1 cause of plantar fasciosis. Footwear that possesses toe spring and a tapered toe box holds your big toe in an adducted and extended position. In this position, your abductor hallucis muscle-the muscle responsible for moving your big toe away from your foot’s midline-pulls on a foot structure called the flexor retinaculum and may restrict blood flow through your posterior tibial artery, the vessel that carries blood to the bottom of your foot. Tissues in the sole of your feet begin to degenerate as blood supply to this area is decreased. Other recognized causes of or contributors to this health problem include the following, calf muscle shortening, plantar fascia contracture, Obesity, rheumatoid arthritis, reactive arthritis, Psoriatic arthritis, Corticosteroid injections.


Symptoms

Symptoms of the plantar fasciitis include a gradual onset of pain under the heel which may radiate into the foot. Tenderness is usually felt under and on the inside of the heel which is initially worse first in the morning but eases as the foot warms up only to return later in the day or after exercise. Stretching the plantar fascia may be painful.


Diagnosis

Plantar fasciitis is one of many conditions causing “heel pain”. Some other possible causes include nerve compression either in the foot or in the back, stress fracture of the calcaneus, and loss of the fatty tissue pad under the heel. Plantar fasciitis can be distinguished from these and other conditions based on a history and examination done by a physician. It should be noted that heel spurs are often inappropriately thought to be the sole cause of heel pain. In fact, heel spurs are common and are nothing more than the bone’s response to traction or pulling-type forces from the plantar fascia and other muscles in the foot where they attach to the heel bone. They are commonly present in patients without pain, and frequently absent from those who have pain. It is the rare patient who has a truly enlarged and problematic spur requiring surgery.


Non Surgical Treatment

Many cases of plantar fasciitis can be treated with simple, conservative measures. These include ice packs, stretching exercises, anti-inflammatory medications, orthotic devices (custom molded orthotics), and physical therapy. It’s important to consult your doctor before you take any medications to treat this condition. In chronic or persistent cases, one of three techniques may be used to treat plantar fasciitis. Extracorporeal Shock Wave Treatment (ESWT). TOPAZ treatment. Platelet Rich P

lasma therapy.

Painful Heel


Surgical Treatment

When more conservative methods have failed to reduce plantar fasciitis pain, your doctor may suggest extracorporeal shock wave therapy, which is used to treat chronic plantar fasciitis. Extracorporeal shock wave therapy uses sound waves to stimulate healing, but may cause bruises, numbness, tingling, swelling, and pain. When all else fails, surgery may be recommended to detach the plantar fascia from the heel bone. Few people need surgery to treat the condition.


Stretching Exercises

Stretching exercises for your foot are important. Do the stretches shown here at least twice a day. Don’t bounce when you stretch. Plantar fascia stretch. To do the plantar fascia stretch, stand straight with your hands against a wall and your injured leg slightly behind your other leg. Keeping your heels flat on the floor, slowly bend both knees. You should feel the stretch in the lower part of your leg. Hold the stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times. Calf stretch. Stand with your hands against a wall and your injured leg behind your other leg. With your injured leg straight, your heel flat on the floor and your foot pointed straight ahead, lean slowly forward, bending the other leg. You should feel the stretch in the middle of your calf. Hold the stretch for 10 to 15 seconds. Repeat the stretch 6 to 8 times. Other exercises. You can also strengthen your leg muscles by standing on the ball of your foot at the edge of a step and raising up as high as possible on your toes. Relax between toe raises and let your heel fall a little lower than the edge of the step. It’s also helpful to strengthen the foot by grabbing a towel with your toes as if you are going to pick up the towel with your foot. Repeat this exercise several times a day.

What Will Cause Pain Of The Heel And The Ways To Treat It

Plantar Fasciitis

Overview

Plantar fasciitis is one of the most common sources of heel pain. Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. Your plantar fascia acts as a passive limitation to the over flattening of you arch. When your plantar fascia develops micro tears or becomes inflammed it is known as plantar fasciitis.


Causes

Plantar fasciitis is caused by drastic or sudden increases in mileage, poor foot structure, and inappropriate running shoes, which can overload the plantar fascia, the connective tissue that runs from the heel to the base of the toes. The plantar fascia may look like a series of fat rubber bands, but it’s made of collagen, a rigid protein that’s not very stretchy. The stress of overuse, overpronation, or overused shoes can rip tiny tears in it, causing pain and inflammation, a.k.a. plantar fasciitis.


Symptoms

Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually worst with the first few steps after awakening, although it can also be triggered by long periods of standing or getting up from a seated position.


Diagnosis

Most cases of plantar fasciitis are diagnosed by a health care provider who listens carefully to your description of symptoms. During an examination of your feet, your health care provider will have to press on the bottom of your feet, the area most likely to be painful in plantar fasciitis. Because the pain of plantar fasciitis has unique characteristics, pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas, your health care provider will probably feel comfortable making the diagnosis based on your symptoms and a physical examination. Your health care provider may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing your pain.


Non Surgical Treatment

Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home. Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery. Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia. Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel,do not apply ice directly to the skin. Limit activities. Cut down on extended physical activities to give your heel a rest. Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia. Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches. Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia. Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis. Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain. Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal. Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients. Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.

Pain In The Heel


Surgical Treatment

In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example, the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that allow blood supply in the area. This will increase the time of recovery.

What Will Cause Painful Heel And The Way To Cure It

Plantar Fasciitis

Plantar Fascia

Overview

Heel pain is a common foot condition. It’s usually felt as an intense pain when using the affected heel. Heel pain usually builds up gradually and gets worse over time. The pain is often severe and occurs when you place weight on the heel. In most cases, only one heel is affected, although estimates suggest that around a third of people have pain in both heels. The pain is usually worse first thing in the morning, or when you first take a step after a period of inactivity. Walking usually improves the pain, but it often gets worse again after walking or standing for a long time. Some people may limp or develop an abnormal walking style as they try to avoid placing weight on the affected heel.


Causes

Plantar fasciitis occurs because of irritation to the thick ligamentous connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue contributes to maintaining the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. Therefore, the stress placed on the this tissue is tremendous.


Symptoms

Plantar fasciitis is characterized by the following signs and symptoms. Acute plantar fasciitis, pain is usually worse in the morning but may improve when activity continues; if the plantar fasciitis is severe, activity will exacerbate the pain, pain will worsen during the day and may radiate to calf or forefoot, pain may be described anywhere from “minor pulling” sensation, to “burning”, or to “knife-like”, the plantar fascia may be taut or thickened, passive stretching of the plantar fascia or the patient standing on their toes may exacerbate symptoms, acute tenderness deep in the heel-pad along the insertion of the plantar aponeurosis at the medial calcaneal tuberosity and along the length of the plantar fascia, may have localized swelling. Chronic plantar fasciitis, plantar fasciitis is classified as “chronic” if it has not resolved after six months, pain occurs more distally along the aponeurosis and spreads into the Achilles tendon.


Diagnosis

Physical examination is the best way to determine if you have plantar fasciitis. Your doctor examines the affected area to determine if plantar fasciitis is the cause of your pain. The doctor may also examine you while you are sitting, standing, and walking. It is important to discuss your daily routine with your doctor. An occupation in which you stand for long periods of time may cause plantar fasciitis. An X-ray may reveal a heel spur. The actual heel spur is not painful. The presence of a heel spur suggests that the plantar fascia has been pulled and stretched excessively for a long period of time, sometimes months or years. If you have plantar fasciitis, you may or may not have a heel spur. Even if your plantar fasciitis becomes less bothersome, the heel spur will remain.


Non Surgical Treatment

Night splints usually are designed to keep a person’s ankle in a neutral position overnight. Most individuals naturally sleep with the feet plantar-flexed, a position that causes the plantar fascia to be in a foreshortened position. A night dorsiflexion splint allows passive stretching of the calf and the plantar fascia during sleep. Theoretically, it also allows any healing to take place while the plantar fascia is in an elongated position, thus creating less tension with the first step in the morning. A night splint can be molded from plaster or fiberglass casting material or may be a prefabricated, commercially produced plastic brace. Several studies have shown that use of night splints has resulted in improvement in approximately 80 percent of patients using night splints. Other studies found that night splints were especially useful in individuals who had symptoms of plantar fasciitis that had been present for more than 12 months. Night splints were cited as the best treatment by approximately one third of the patients with plantar fasciitis who tried them. Disadvantages of night splints include mild discomfort, which may interfere with the patient’s or a bed partner’s ability to sleep.

Heel Pain


Surgical Treatment

In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example, the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that allow blood supply in the area. This will increase the time of recovery.