Heel Pain Has Many Causes-



In our pursuit of health, pain plays the enemy role. In some instances, however, it does possess  biological benefit. Pain that occurs as a result of injury or early in an illness may play a protective role, often warning us about the damage we've suffered.

When we sprain an ankle, for example, the pain warns us that the ligament and soft tissues may be frayed and bruised, and that further activity may cause additional injury.

Pain, such as may occur in our heels, also alerts us to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain.

Heel Pain



Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that are attached to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poor fitting and poorly constructed footwear; or carrying excess weight.

The largest of the 26 bones in the human foot is the heel. The foot is also made up of  33 joints and a network of more than 100 muscles, tendons, and ligaments. Like all bones, the heel is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes even disabling to sufferers, can occur in the front, back, or bottom of the heel.

Heel Spurs

A common cause of heel pain is the occurence of a heel spur. A heel spur is a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition may be referred to as "heel spur syndrome."

Heel spurs form as a result from strain on the muscles and ligaments of the foot, by the stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, jogging or running, improperly fitting or excessively worn shoes, or obesity.

Plantar Fasciitis

Both heel pain and heel spur pain is  frequently associated with an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. This type of inflammation is called plantar fasciitis. Plantar fasciitis is common among athletes who run and jump a lot, and it can be quite painful.

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

Inflammation may be aggravated by shoes which lack enough support for the foot, especially in the arch area, and by the chronic irritation that sometimes accompanies a person's athletic lifestyle.

Resting your feet only provides temporary relief. When you resume walking, particularly after a night's sleep, you may feel a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that could just be a false sense of relief. The heel pain often returns after extensive walking or prolonged rest .

Excessive Pronation

Excessive pronation is sometimes causes heel pain. Pronation is the normal flexing motion and flattening of the arch of the foot that allows it to absorb shock in the normal walking pattern and adapt to ground surfaces.

When you walk, the first contact is made between the heel and the ground; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the weight of the body and move it forward. Excessive pronation, also known as excessive inward motion, can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the knee, hip, and lower back.

Disease and Heel Pain

There are other general health conditions which can also cause heel pain:

  • Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint area, can cause heel discomfort in some cases.
  • Heel pain may also result because of an inflamed bursa also known as a bursitis, which is a small, irritated sack of fluid; a neuroma (a nerve growth); or other soft-tissue growth. This type of heel pain may be associated with a heel spur.
  • Haglund's deformity ("pump bump") is a bone enlargement at the back of the heel bone, in the area where the achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe.
  • Bone bruises are heel injuries which occur commonly. A bone bruise or contusion is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard surface or object on the foot.
  • Back of the heel pain is often associated with inflammation of the achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. This type of inflammation is named achilles tendinitis. It is most commonly found among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to pain, inflammation, and the possible growth of a bone spur on the back of the heel bone. The inflammation can easily be further aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.

Although infrequently, stress fractures of the heel bone also can occur.

Children’s Heel Pain

Heel pain also occurs in children, most commonly between the ages of  8 and 13, as they become increasingly active in sports activity inside and outside of school. This type of physical activity, particularly jumping, tends to inflame the growth centers of the heels; the more active the child is, the more likely the condition is to occur. When the child's bones mature, the problems disappear and are not likely to happen again. If heel pain occurs in this age range, podiatric care is necessary to protect the growing bone and to help provide pain relief. Heel spurs are not likely to develop in children. Heel sputs are not likely to develop in children.

Prevention

A number of steps can be taken to avoid heel pain and any accompanying afflictions:

  • Wear the proper shoes for each activity you do.
  • Wear shoes that fit your feet well—front, back, and sides—and have rigid shanks, shock-absorbent soles, and supportive heel counters.
  • Avoid wearing shoes with excessive wear on heels or soles.
  • Prepare properly before exercising. Warm up and do stretching exercises before and after running or jogging.
  • Pace yourself when you participate in athletic activities.
  • If obese, lose weight.
  • Don’t underestimate your body's need for rest and good nutrition.

Podiatric Medical Care

If experiencing pain or other symptoms of inflammation, which include redness, swelling, or heat, you should limit normal daily activities and contact a doctor of podiatry.

The podiatric physician will examine the painful or inflamed area and may perform diagnostic X-rays to rule out problems of the bone.

Early treatment of heel spurs might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or other orthotic devices. Taping or strapping of the foot provides extra support, placing stressed tendons and muscles in a physiologically restful state. Physical therapy may be used in addition to such treatments.

A functional orthotic device may be prescribed by your foot and ankle specialist for correcting biomechanical imbalance, supporting of the ligaments and tendons attaching to the heel bone, and controlling excessive pronation. These types of devices will effectively treat the majority of heel and arch pain without the need for surgery.

Relatively, only a few cases of heel pain require more complicated treatments or surgery. If surgery is deemed necessary, it may involve the release of the plantar fascia, removal of a bursa, removal of a spur, or removal of a neuroma or other soft-tissue growth.

Heel Pain Tips

  • If you are or have experienced painful heels, try wearing your shoes around your house in the evening. Don't wear socks or slippers or go barefoot. You could also try gentle calf stretches for a duration of 20 to 30 seconds on each leg. Calf stretching is best done barefoot, by leaning forward towards a wall with one foot forward and one foot back.
  • If your heel pain persists for longer than one month, you should visit a podiatrist for evaluation and treatment. Your feet should not hurt, and professional podiatric care may be required to help relieve your discomfort.
  • Begin an exercise program slowly. Don't go too far or too fast.
  • If you have not exercised in a long time, consult your podiatric physician before starting a new exercise program.
  • Purchase and maintain well-fitting shoes in good condition and replace them regularly.
  • Stretch each foot and achilles tendon before and after exercise.
  • Do your best to avoid uneven walking surfaces or stepping on rocks as much as possible.
  • You should avoid walking barefoot on hard surfaces.
  • If it hurts, stop. Don't try to "work through the pain."
  • Vary the incline on a treadmill during exercise. Nobody walks uphill all the time.