Heel pain is a significant and common problem for patients in my practice. It can be debilitating and frustrating, and can occur from many different pathologies.
Common types of heel pain include plantar fasciitis (more commonly referred to as ‘heel spurs’ or ‘heel spur syndrome’), fractures, types of tendonitis, or nerve pain or entrapment. Each of these has different causes and different treatments, and pain may start acutely (‘all of a sudden’) or insidiously (when the problem progresses more slowly over a period of time.)
Plantar Fasciitis is by far the most common type of heel pain seen in my Podiatry practice. Pain is most often at the medial (inside) aspect of the heel, but can span across the medial arch of the foot and even into the ball of the foot. This disorder is named after the ligamentous structure, the plantar fascia, which runs from the heel to the ball of the foot in 3 bands. When the arch begins to collapse (often because of loosening of ligaments as we get older, weight gain, or increased activity), a great deal of tension is put across the plantar fascia, and it begins to tighten up like a rubber band. This tension causes strain and inflammation, and creates pain.
Symptoms of plantar fasciitis include pain after periods of rest and with the first step in the morning. Symptoms may also include burning pain across the arch and a feeling of debilitation and constant strain. Patients often have such severe symptoms that they have difficulty standing or working for long periods of time.
Treatment for plantar fasciitis may include stretching, icing, rest, athletic strappings, therapeutic ultrasound, local injections with corticosteroids, and sometimes physical therapy. Surgery is rarely indicated unless pain has not resolved after 7-9 months of conservative treatments.
Fractures of the calcaneus, or heel bone, are not very common, and usually occur after a fall from a height of 8-10 feet or more. These are very traumatic episodes, and patients who suffer these injuries are often transported directly to a hospital. Surgery is often indicated to repair these fractures, as the calcaneous is a very hollow bone which may require reconstruction when broken.
Occasionally a patient may suffer a stress fracture of the calcaneus. These fractures are rare and may require testing, such as a bone scan, to be identified. A stress fracture is a ‘hairline fracture’ which occurs from repetitive stress on a bone. Symptoms my start insidiously, and then progress to a very annoying and painful situation.
All fractures require a prolonged period of immobilization (casts or walking boots, depending on the severity). Surgery is more often required for a traumatic fracture than a stress fracture.
Most Tendons and the nerves traveling to the foot come from above the ankle in the lower extremities. Tendons and nerves may travel through a serious of canals and openings between bones and muscles, and an impingement of a nerve or a tendonitis may occur as these structures change course and pass through these openings. The function of the foot may also cause impingement of structures, particularly in the tarsal canal at the inside of the ankle. This occurs most often in people with a decreased medial arch (flat foot), and, if not too severe, may be helped by orthotics and physical therapy. More severe impingements may require tendon repair or nerve releases through surgical intervention.
If you have heel pain, don’t hesitate to see your Podiatrist or Family Doctor. The longer some of these problems persist, the more difficult they may be to treat.