Heel Pain

Do you feel a stabbing pain in your heel with your first steps out of bed in the morning? You’re not alone! Every day, thousands of Americans suffer from this condition. Plantar fasciitis, more commonly known as heel pain, is by far the most common complaint patients bring to podiatric physicians.  Aching heels can truly affect your lifestyle and disrupt essential activities and prevent you, to a large extent, from playing sports or simply going for a walk. An accurate and expedient diagnosis of the cause of your symptoms will help you receive the appropriate treatment.  There are several causes of heel pain. The most common include:

✿Plantar Fasciitis – 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. Both heel pain and heel spurs are frequently associated with plantar fasciitis.

✿ Heel Spurs – 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. Heel spurs can result from strain on the ball of the foot and repeated tearing away of the lining or membrane that covers the heel bone. Contrary to popular belief, heel spurs are generally not the cause of pain—the pain you may feel is from inflammation of the plantar fascia.

✿ Excessive Pronation – Excessive inward motion can create an abnormal amount of stretching and pulling on the ligaments and tendons that attach to the bottom back part of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.

✿ Achilles Tendinitis – Pain at the back of the heel is associated with Achilles tendinitis, which is inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. Other possible causes of heel pain include rheumatoid arthritis and other forms of arthritis (e.g., gout); Haglund’s deformity (a bone enlargement at the back of the heel bone in the area where the Achilles tendon attaches to the bone); inflamed bursa (“bursitis”), a small, irritated sac of fluid;  neuromas (nerve growths) or other soft-tissue growths; and bruises or contusions, which involve 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 object or surface on the foot. Some contributing factors associated with heel pain are age (with increasing age, often there is decreasing flexibility); any sudden change in activity (particularly activities that increase weight bearing or pressure on the foot); flat, pronated feet or high-arched feet; a sudden increase in weight; pregnancy; stress from an injury; a bruise incurred while walking, running, or jumping on hard surfaces; or medical conditions such as tarsal tunnel syndrome.  Seeking medical attention from your podiatric physician is the first line of defense in treating heel pain. However, there are several steps you can take to avoid heel pain in the first place:

Ø      Wear shoes that fit well and have shock-absorbent soles, rigid shanks (the part of the shoe that supports the foot and helps give a shoe its structure), and a supportive heel counter (the rear-most part of the shoe, at the back of the heel above the sole).

Ø      Wear the proper shoes for each activity.

Ø      Do not wear shoes with excessive wear on heels or soles.

Ø      Begin exercises slowly. Consult with your podiatric physician before beginning a new exercise program.

Ø      Wear athletic shoes with good shock support in the heels.

Ø      Purchase shoes that fit.

Ø      Avoid activities that may put constant strain on the foot.

Ø      Avoid going barefoot on all surfaces.

Ø      If obese, lose weight.

A variety of treatment solutions are available to provide short and long-term pain relief. Begin treating heel pain by avoiding all sorts of pressure or tension on the inflamed area, giving your feet ample rest. Applying ice and heat packs in alternating fashion will greatly accelerate the process of healing. Another option is the use of custom insoles created by your podiatric physician. Custom insoles may assist with treating active conditions of heel pain and likewise reduce the risk for reoccurrence. The custom insole will restore body balance and prevent the plantar fascia from experiencing strain when you walk. If all non-invasive treatment solutions do not work, surgery is probably the best next option. Regular exercise for calf muscles and the plantar fascia is necessary to alleviate pain and improve flexibility of the affected muscle. These exercises are advised for both legs even if the pain is in one heel only. Some of the most beneficial exercises are:

✿ Towel stretches – This exercise should be done every morning before you leave your bed. Make a loop with a towel and use it to pull your toes toward your body, while keeping the knee straight. Stretch each foot three times, and hold each stretch for 30 seconds, if possible.

✿ Stair stretches – Stand tall on a staircase with the balls of both feet on the edge of the step. Place hands on the railing or the wall for balance and support. Slowly lower heels toward the floor until you feel a stretch in your lower leg and heels. Maintain the stretch for 10 to 15 seconds. Repeat this exercise six times, and perform the stretches twice every day.

✿ Wall-leaning Stretch – Stand an arm’s length away from a wall, place both hands on the wall at shoulder height, with the feet slightly apart and one foot in front of the other. Your front knee should be bent, but the back knee should be straight while you lean toward the wall. Hold the position for 10 seconds at a time for up to 15 or 20 repetitions per leg. If you are unsure of the cause of your symptoms, if pain is severe, or if you have the following symptoms, call a podiatric physician immediately:

Ø      Inability to bend your foot downward.

Ø      Inability to rise on your toes.

Ø      Inability to walk comfortably on the affected side.

Ø      Swelling or discoloration of the back of the foot.

Ø      Heel pain that occurs at night or while resting.

Ø      Heel pain that persists beyond a few days.

Heel pain does not always subside quickly after medical attention is received. Unfortunately, it may take several months before the pain is actually gone. In most cases, heel pain can be treated at home under a podiatric physician’s supervision.

Information from the American Podiatric Medical Association

 

For many athletes and weekend exercise warriors, winter is a time

to enhance their cardiovascular health. Many partake in winter

sports such as sledding, skiing, snowboarding, rough-and-tumble

ice hockey, or casual ice skating. Winter sports offer a fast track

for fun, but expose the body to injuries, especially foot and ankle

injuries.

Some common winter and snow sports injuries related to the foot

and ankle include:

• Frostbite – The symptoms of frostbite include skin-color changes,

from blue to whitish, and a feeling of burning or numbness;

• Blisters – Friction in winter sports footwear often causes blisters;

• Neuromas – Enlarged benign growths of nerves between the toes

are caused by friction in tight footwear and can result in pain,

burning, tingling, or numbness. Neuromas require professional

treatment, including an evaluation of skates and boots, from a

podiatric physician;

• Sprains and strains – The stress of skiing and skating can result

in sprains and strains of the foot and ankle. They can be treated

with rest, ice, compression, and elevation (RICE). If pain persists,

seek medical attention from a podiatric physician; and

• Subungual hematoma – Pressure in the toe box of a ski or skate

can cause bleeding under the toenail known as a subungual

hematoma. This condition should be treated by a podiatric

physician to prevent the loss of a toenail.

Podiatric physicians recommend properly fitted shoes or boots

to prevent winter and snow injuries. With adequate preparation

and proper equipment, you can prevent most injuries common to

winter and snow sports.

• Maintain an adequate fitness level all year round. Being fit is the

best way to avoid many sports-related injuries in winter.

• Find a buddy who enjoys your sport. Never participate in winter

sports alone.

• Warm up thoroughly before activity. Cold muscles, tendons,

and ligaments are vulnerable to injury. Make sure to cool down

thoroughly afterwards, as well.

• Wear several

layers of light,

loose, waterand-

wind-resistant

clothing for warmth

and protection.

• Wear proper footwear that is

in good condition and keeps feet

warm and dry. Footwear should provide

ample ankle support, as well.

• Wear appropriate protective gear, including

goggles, helmets, gloves, and padding.

• Wear a blended sock that “wicks” sweat away from the skin.

Consult your podiatric physician for recommendations.

• Drink plenty of water before, during, and after your sports

activity.

• Move to a warm, dry environment if your feet get wet. The skin

tissues of wet, cold feet are in danger of freezing (frostbite).

 

Information courtesy of the American Podiatric Medical Association

DID YOU KNOW...

• Each foot has 25 bones - both feet contain nearly one quarter of all the bones in the body (206 bones)
• There is an intricate network of over 100 tendons, ligaments, and muscles in each foot
• Every step places 1.5 times your body weight of pressure on your foot (a 150 pound person places 225 pounds of pressure on the foot with every step)
• The average person walks 5,000 to 7,000 steps a day. 
• A person will walk nearly 100,000 miles in a lifetime, between three and four times the earth's circumference!