The function of the heel in walking is to absorb the shock of your foot striking the ground as it is put down and to start springing you forward on the next step. It contains a strong bone (the
calcaneum). Under the bone are a large number of small pockets of fat in strong elastic linings, which absorb much of the shock (fat pads). The heel is attached to the front of the foot by a number
of strong ligaments which run between the front part of the calcaneum and various other parts of the foot. The strongest ligament is the plantar fascia, which attaches the heel to the toes and helps
to balance the various parts of the foot as you walk. It therefore takes a lot of stress as you walk. In some people the plantar fascia becomes painful and inflamed. This usually happens where it is
attached to the heel bone, although sometimes it happens in the mid-part of the foot. This condition is called plantar fasciitis and causes Heel Pain
Common causes of heel pain include Achilles tendinitis, Achilles tendon rupture, Bone tumor, Bursitis, Fibromyalgia, Fracture, Gout, Heel pad wear and tear, Heel spur, Osteomyelitis, Peripheral
neuropathy, Pinched nerve, Plantar fasciitis, Rheumatoid arthritis, Stress fractures, Tarsal tunnel syndrome, Tendinitis. Causes shown here are commonly associated with this symptom. Work with your
doctor or other health care professional for an accurate diagnosis.
The heel can be painful in many different ways, depending on the cause. Plantar fasciitis commonly causes intense heel pain along the bottom of the foot during the first few steps after getting out
of bed in the morning. This heel pain often goes away once you start to walk around, but it may return in the late afternoon or evening. Although X-ray evidence suggests that about 10% of the general
population has heels spurs, many of these people do not have any symptoms. In others, heel spurs cause pain and tenderness on the undersurface of the heel that worsen over several months. In a child,
this condition causes pain and tenderness at the lower back portion of the heel. The affected heel is often sore to the touch but not obviously swollen. Bursitis involving the heel causes pain in the
middle of the undersurface of the heel that worsens with prolonged standing and pain at the back of the heel that worsens if you bend your foot up or down. Pump bump, this condition causes a painful
enlargement at the back of the heel, especially when wearing shoes that press against the back of the heel. Heel bruises, like bruises elsewhere in the body, may cause pain, mild swelling, soreness
and a black-and-blue discoloration of the skin. Achilles tendonitis, this condition causes pain at the back of the heel where the Achilles tendon attaches to the heel. The pain typically becomes
worse if you exercise or play sports, and it often is followed by soreness, stiffness and mild swelling. A trapped nerve can cause pain, numbness or tingling almost anywhere at the back, inside or
undersurface of the heel. In addition, there are often other symptoms, such as swelling or discoloration - if the trapped nerve was caused by a sprain, fracture or other injury.
The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present
and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.
Non Surgical Treatment
Early treatment might involve exercise and shoe recommendations, taping or strapping and anti-inflammatory medication (such as aspirin). Taping or strapping supports the foot, placing stressed
muscles in a restful state and preventing stretching of the plantar fascia. Other physical therapies may also be used, including ice packs and ultra-sounds. These treatments will effectively treat
the majority of heel and arch pain without the need for surgery.
When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing
to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most
beneficial for your condition.
You can reduce the risk of heel pain in many ways, including. Wear shoes that fit you properly with a firm fastening, such as laces. Choose shoes with shock-absorbent soles and supportive heels.
Repair or throw out any shoes that have worn heels. Always warm up and cool down when exercising or playing sport, include plenty of slow, sustained stretches. If necessary, your podiatrist will show
you how to tape or strap your feet to help support the muscles and ligaments. Shoe inserts (orthoses) professionally fitted by your podiatrist can help support your feet in the long term.