Understanding Heel Pain

Overview

Painful Heel

Heel Pain may develop when you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues. A sore heel will usually get better on its own if you give it enough rest. Unfortunately, many people try to ignore the early signs of heel pain and keep on doing the activities that caused it and this can lead to chronic pain. Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel. Pain beneath the Heel. If it hurts under your heel, you may have one or more conditions that cause inflammation of the tissues on the bottom of your foot. Stone bruise. By stepping on a hard object, you can bruise the fat pad on the bottom side of your heel. It may or may not look discoloured. With rest, the pain subsides gradually.

Causes

There is no one cause of heel pain. Whole text books have been written on Disorders of the Heel. Some of the types of problems that can be seen in the heel include Heel spurs, these are small bony spurs that often develop on the bottom of the heel. They do not really cause any problems. It is only mentioned here as it is a common myth that they are a problem – almost always the pain associated with heel spurs is really plantar fasciitis. Plantar fasciitis is the most common cause of heel pain and is due to a strain of the long ligament along the bottom of the foot. The most symptom is pain when getting out of bed first thing in the morning (‘post-static dyskinesia’) A number of disease processes can uncommonly cause heel pain, such as rheumatoid arthritis, ankylosing spondylitis and gout. Stress fractures, which is an abnormal reaction of bone to stress can occur in those that are very active (eg athletes) or have weaker bones (eg osteoporosis) Pain at the back of the heel could be due to a number of problems, there could be a bursitis at the back of the heel bone (sometimes called ‘Haglund’s) there could be problems with the insertion of the achilles tendon, such as tendonitis or calcification. A ‘stone’ bruise is sometimes considered to be a cause of heel pain, its is simply a bruise of the bone. Another cause of heel pain is problems in the calf muscles that refer pain to the heel (myofascial trigger points) or pain referred from the lower back via the nerves from the back to the heel. Heel pain in children is usually due to severs disease or calcaneal apophysitis.

Symptoms

The symptoms of plantar fasciitis are classically pain of a sharp nature which is worse standing first thing in the morning. After a short period of walking the pain usually reduces or disappears, only to return again later in the day. Aggravating times are often after increased activity and rising from sitting. If these are the sort of symptoms you are experiencing then the Heel-Fix Kit ? will be just the treatment your heel is crying out for. Some heel pain is more noticeable at night and at rest. Because plantar fasciitis is a mechanical pathology it is unlikely that this sort of heel pain is caused by plantar fasciitis. The most common reason for night heel pain is pressure on your Sciatic nerve causing referred pain in the heel. Back pain is often present as well, but you can get the heel pain with little or no back pain that is caused by nerve irritation in the leg or back. If you get pain in your heels mainly or worse at night please see a clinician as soon as you can to confirm the diagnosis.

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

Physical medicine modalities are well known for their benefits and they have been consistently applied in early treatment of plantar fasciitis. Typically, the direct application of ice, ice baths or contrast soaking aid in the local reduction of inflammation and temporarily augment pain management. Electric stimulation may only provide indirect reduction of interstitial inflammation of the plantar fascia. Ultrasound therapy, hot pack systems and deep tissue massage help eliminate inflammation and aid in restoring plantar fascia tensegrity. Generally, these modalities are considered to be valuable adjuncts to a well-organised treatment plan. Various programs of stretching, range of motion and therapeutic exercises can help re-establish foot function and improve tolerance to load. When it is done appropriately, stretching can serve as an important adjunct to the resumption of the plantar fascia?s ability to tolerate eccentric loading forces that typically occur during stance and gait. Night splinting has proven to be an effective tool in managing persistent plantar fasciitis. Antiinflammatory modalities, such as ice and ice baths, are often the first line of treatment. Oral NSAIDs have been a mainstay of treatment. While they effectively relieve symptoms, be aware that they frequently fail to promote sustained relief. When inflammation is severe or fails to respond to initial efforts, one may consider corticosteroid injection(s). However, keep in mind that corticosteroid injections impose the risk of aponeurosis rupture secondary to focal collagen tissue necrosis and can result in focal heel fat pad atrophy.

Surgical Treatment

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.

Prevention

Painful Heel

You can help to prevent heel pain by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch of the foot and cushion the heel. If you are prone to plantar fasciitis, exercises that stretch the Achilles tendon (heel cord) and plantar fascia may help to prevent the area from being injured again. You also can massage the soles of your feet with ice after stressful athletic activities. Sometimes, the only interventions needed are a brief period of rest and new walking or running shoes.

10 Steps To Effective Relief From Plantar Fasciitis (Heel Pain)

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Pain is the most common symptom for which older adults, those aged 65 and older, visit their doctor. The older adult population is rapidly increasing as the baby boomers age. Pain is often considered by experts to be a silent epidemic in the United States. An estimated 50 million Americans live with chronic pain caused by disease, disorder or accident. An additional 25 million people suffer acute pain resulting from surgery or accidents. Length of relief from pain, per occurrence, is also important to the sufferer. In a (4)study, TFT provided longer relief than that experienced from pain medications. (a free copy of this study is available on ).

The most common display of faulty foot biomechanics is ‘over-pronation’. Over-pronation is a condition whereby the arches are lowered and the feet and ankles rolling inwards excessively during walking and running. It is believed by podiatrists that over 70% of the population actually suffers from mild to severe over-pronation. Over-pronation should not be confused with flat feet (Pes Planus). Only 5% of the population is flat-footed, i.e. no arch is present whatsoever under the foot. Over-pronators on the other hand do have an arch present, but the arch will lower significantly during walking and running, and the ankles will twist inwards.

People with tight calf muscles are unable to walk steady and they prone to fall, since there is difficulty for the heel striking the ground. When we are relax standing, soleus muscle stabilises the leg so that the weight line can fall in front of the knee. However, if you have tight calf muscles, you might have lower back pain, because it increases stress on the low back muscle. Too many shoes these days are using soft materials all-around the shoes and are very ‘floppy’ giving no support or stability whatsoever. In summer, many people wear open footwear such as sandals and flip-flops which are even worse in biomechanical terms.heel pain in children

In a recent press release, researchers announced that they have begun to study the biomechanics of how the foots connective tissues and muscles work so that they can address the problem of chronic heel pain. By understanding the biomechanics of chronic heel pain, physicians will be better able provide more specialized treatment. Additional research will utilize magnetic resonance imaging (MRI) and spectroscopy (MRS). Researchers will be studying the results to determine what causes the biomechanics of the foot to work in this way. People who do not have chronic heel pain do not have the same biomechanics at work while they walk or move.

Plantar fasciitis can occur as the result of excessive running and jumping in gymnastics. The plantar fascia is the thick band of tissue on the bottom of your foot that connects your heel bone to your toes. Plantar fasciitis occurs as the result of inflammation of this band of tissue due to overuse. The pain tends to be localized to your heel. The pain is mild at first and tends to increase with physical activity. Plantar fasciitis is commonly treated with rest, ice, anti-inflammatory medications, physical therapy and possible steroid injections. Achilles Tendinitis

Pain anywhere on the foot – the degree, location and kind of pain vary among the several conditions mentioned above. For example, a heel spur exhibits a dull pain that gradually grows in intensity over time, while with a tarsal tunnel syndrome, the pain is more like a shooting pain inside the ankle or at the bottom of the feet. Whatever pain it is you are feeling, it is a sign that you have a heel problem, and that you should pay attention to it. Rest – Avoid long hours of walking and strenuous activity. Take regular breaks in between and always make sure that your feet are well rested.

Do not wait any longer to begin finding ways to stop the discomfort of heel spurs or an overstretched plantar fascia. Heel spurs do not go away by themselves, but the pain they cause can be controlled. Visit a podiatrist as soon as possible, and do all you can to stop the pain of an overstretched plantar fascia and/or heel spurs. You do not have to live with the pain. Ice – place an ice-pack on the affected area for about 15 minutes. Do not place bare ice directly onto skin.