The heel bone is the largest of the 26 bones in the human foot. But while it is a large, strong bone, it is often injured, and this pain can be quite disabling at times. Heel Pain
can occur in the front, back, sides or bottom of the heel. That the heel is
commonly injured is not surprising, perhaps, given the amazing amount of stress it must endure during a day. Indeed, it is one of the most common injuries of the foot; we see some variation of heel
pain in our offices an average of 5 or 6 times per day.
Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel may become tender or swollen from shoes with poor support or shock absorption, running on hard
surfaces, like concrete, running too often, tightness in your calf muscle or the Achilles tendon. Sudden inward or outward turning of your heel, landing hard or awkwardly on the heel. Conditions that
may cause heel pain include when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot, swelling of the fluid-filled sac (bursa) at the
back of the heel bone under the Achilles tendon (bursitis). Bone spurs in the heel. Swelling of the thick band of tissue on the bottom of your foot (plantar fasciitis). Fracture of the heel bone that
is related to landing very hard on your heel from a fall (calcaneus fracture).
Initially, this pain may only be present when first standing up after sleeping or sitting. As you walk around, the muscle and tendon loosen and the pain goes away. As this problem progresses, the
pain can be present with all standing and walking. You may notice a knot or bump on the back of the heel. Swelling may develop. In some cases, pressure from the back of the shoe causes pain.
A biomechanical exam by your podiatrist will help reveal these abnormalities and in turn resolve the cause of plantar fasciitis. By addressing this cause, the patient can be offered a podiatric
long-term solution to his problem.
Non Surgical Treatment
Initial treatment consists of rest, use of heel cushions to elevate the heel (and take tension off the Achilles), stretching and applying ice to the area. You can ice and stretch the area
simultaneously by filling a bucket with ice and cold water and placing the foot flexed with the toes upward so that the Achilles tendon region is bathed in the cold water for 10 to 15 minutes twice a
day. The Achilles region can also become inflamed around the tendon, called paratendinosis. This condition can be treated with the ice bucket stretching, rest and physical therapy. Another area that
is commonly subjected to problems is the attachment of the Achilles near or on the heel bone. The heel (calcaneus) itself can have an irregular shape to it, causing irritation to the Achilles as it
twists over the region and inflames the bursa, a naturally occurring cushion. Shoes can often aggravate this condition. Sometimes over-stretching, such as the Achilles stretch with the knee bent, can
irritate the tendon and cause a bursitis. Prescription foot orthoses can help reduce the torque of the Achilles tendon in these types of cases. Often, the Achilles tendon calcifies near its
attachment due to constant torque and tension. Repetitive stress can cause this calcific spur to crack, creating a chronic inflammatory situation that can require surgery. All of these types of
chronic Achilles tendinosis that require surgery are successfully treated in over 90 percent of the cases. As with most foot surgery, complete recovery can take up to a year. Though heel pain is
common and can be chronic, it does not have to be your weakness (as was the case with the warrior Achilles from Greek mythology).
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue
to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you. No matter what
kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive
shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
Preventing heel pain is crucial to avoid pain that can easily interrupt a busy or active lifestyle. Athletes can prevent damage by stretching the foot and calf both before and after an exercise
routine. The plantar fascia ligament can be stretched by using a tennis ball or water bottle and rolling it across the bottom of the foot. With regular stretching, the stretching and flexibility of
tissue through the foot can be significantly improved, helping to prevent damage and injury. Athletes should also ease into new or more difficult routines, allowing the plantar fascia and other
tissue to become accustomed to the added stress and difficulty. Running up hills is also common among athletes in their routines. However, this activity should be reduced since it places an increased
amount of stress on the plantar fascia and increases the risk of plantar fasciitis. Maintaining a healthy weight is also an essential heel pain prevention technique. Obesity brings additional weight
and stress on the heel of the foot, causing damage and pain in the heel as well as in other areas of the foot.