All About Heel Pain

Do you feel pain under the heel or just behind it while standing, walking or running?  Are you limping or developing an abnormal style of walking?

Causes

Possible causes of heel pain include:

  •         Mechanical imbalances
  •         Repetitive trauma
  •         Arthritis
  •         Infection
  •         Neurological problems
  •         Autoimmune disorders, or other systemic conditions affecting the whole body. 
  •         Policeman's heel
  •         Stress fractures
  •         Chronic inflammation of the heel pad
  •         Fat pad atrophy
  •         Heel bursitis
  •         Heel bumps
  •         Tarsal tunnel syndrome
  •         Achilles tendonosis
  •         Ankylosing spondylitis
  •         Heel spurs
  •         Calcaneal fracture
  •         Calcaneal stress fracture
  •         Medial calcaneal nerve entrapment
  •         Lateral plantar nerve entrapment
  •         Talar stress fracture
  •         Achilles bursitis
  •         Gout
  •         Bone bruise
  •         Osteoid osteoma
  •         Morton's neuroma
  •         Spondyloarthropies
  •         Regional complex pain syndrome

Additionally, people between 40-60 years of age are prone to heel pain.  Sever’s Disease occurs mainly in active children aged 8 to 15 years, resulting in pain and tenderness at the back of the heel while walking, while running, and during sports . Pain vanishes after a period of rest and resumes again during the training.

But most commonly, heel pain is caused by plantar fasciitis (inflammation of the plantar fascia).

The plantar fascia is a strong bowstring-like ligament that runs from the calcaneus (heel bone) to the front of the foot. When the plantar fascia is stretched too far, its soft tissue fibers become inflamed, usually where it attaches to the heel bone. Sometimes, the problem may occur in the middle of the foot. The patient experiences pain under the foot, especially after long periods of rest. Some patients may also experience calf muscle cramps if the Achilles tendon tightens as well.

Normally, the pain builds up gradually over time, but can get to be excruciating.  Mild conditions may vanish on their own but can progress into a chronic condition if left untreated. 

Prevention

An ounce of prevention is worth a pound of cure!  Here’s how you can minimize the chances of getting heel pain.

  • Maintain a healthy weight.  Being overweight can place excess pressure and strain on your feet, particularly on your heels.
  •  Do not walk barefoot on hard ground.
  •  Warm up and stretch before exercising, and wear supportive shoes for sports.

Treatment

Treatment options include:

  •         Wearing supportive, proper fitting shoes - preferably canvas shoes. Replace shoes at regular intervals, and avoid high heels.
  •         Resting your heels – take short breaks during long periods of walking or standing.
  •         Regular stretching and mild exercises for your calf muscles and plantar fascia.  These exercises can be taught by your Toronto podiatrist.
  •         Athletic taping, which may give the bottom of the foot better support.
  •         Extracorporeal shock wave therapy, which can encourage and stimulate healing.
  •         Applying ice for 15-minute intervals on the affected heel.
  •         Non-steroidal anti-inflammatory medications (NSAIDs), or other medications, such as corticosteroids, as deemed appropriate by a podiatrist,.
  •         Use of supportive devices such as orthotics or night splints.