Every mile you walk puts tons of stress on each foot. Your feet can handle a heavy load, but too much stress pushes them over their limits. When you pound your feet on hard surfaces playing sports or
wear shoes that irritate sensitive tissues, you may develop Heel Pain
, the most common problem affecting the foot and ankle. A
sore heel will usually get better on its own without surgery if you give it enough rest. However, many people ignore the early signs of heel pain and keep on doing the activities that caused it. When
you continue to walk on a sore heel, it will only get worse and could become a chronic condition leading to more problems.
There are many possible causes of heel pain. Most commonly it is a chronic, long-term pain that results of some type of faulty biomechanics (abnormalities in the way you walk) that place too much
stress on the heel bone and the soft tissues that attach to it. Chronic pain is a common result of standing or walking too many hours in the course of a day, working on concrete, being overweight,
wearing poorly-constructed shoes, having an overly-pronated foot type (where the arch collapses excessively) or the opposite--having too high an arch. Women seem to get this slightly more often than
men, and while any age can be affected, it usually occurs between 30 and 50 years of age. The other type of heel pain is the sort you get from an acute injury--a bruise to the bone or soft tissue
strain resulting from a strenuous activity, like walking, running, or jumping, or from some degree of trauma. While there are dozens of possible causes to heel pain, I will review some of the more
common causes. Arch Pain/Plantar Fasciitis. One of those often-painful soft tissue that attaches to heel spurs at the bottom of the foot is called "plantar fascia". Fascia, located throughout the
body, is a fibrous connective tissue similar to a ligament. You can see fascia as some of that white, connective tissue attaching to bones, when you pull apart meat. The "plantar" fascia in our
bodies is that fascia which is seen on the bottom (or plantar portion) of the foot, extending from the heel bone to the ball of the foot. Compared to other fascia around the body, plantar fascia is
very thick and very strong. It has to be strong because of the tremendous amount of force it must endure when you walk, run or jump. But while the plantar fascia is a strong structure, it can still
get injured, most commonly when it is stretched beyond its normal length over long periods of time. Plantar Fascitis. When plantar fascia is injured, the condition is called "plantar fasciitis",
pronounced "plan-tar fash-I-tis". (Adding "-itis" to the end of a word means that structure is inflamed.) It is sometimes known more simply as 'fasciitis'. Plantar fasciitis is the most common type
of arch pain. Symptoms of plantar fasciitis may occur anywhere along the arch, but it is most common near its attachment to the heel bone.
Plantar fascia usually causes pain and stiffness on the bottom of your heel although some people have heel spurs and suffer no symptoms at all. Occasionally, heel pain is also associated with other
medical disorders such as arthritis (inflammation of the joint), bursitis (inflammation of the tissues around the joint). Those who have symptoms may experience ?First step? pain (stone bruise
sensation) after getting out of bed or sitting for a period of time. Pain after driving. Pain on the bottom of your heel. Deep aching pain. Pain can be worse when barefoot.
The diagnosis of plantar fasciitis is generally made during the history and physical examination. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished
from these conditions. Pain can be referred to the heel and foot from other areas of the body such as the low back, hip, knee, and/or ankle. Special tests to challenge these areas are performed to
help confirm the problem is truly coming from the plantar fascia. An X-ray may be ordered to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to
cause problems. Other helpful imaging studies include bone scans, MRI, and ultrasound. Ultrasonographic exam may be favored as it is quick, less expensive, and does not expose you to radiation.
Laboratory investigation may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter's syndrome, or ankylosing spondylitis. These are
diseases that affect the entire body but may show up at first as pain in the heel.
Non Surgical Treatment
Treatment includes resting from the activities that caused the problem, doing certain stretching exercises, using pain medication and wearing open-back shoes. Your doctor may want you to use a 3/8"
or 1/2" heel insert. Stretch your Achilles tendon by leaning forward against a wall with your foot flat on the floor and heel elevated with the insert. Use nonsteroidal anti-inflammatory medications
for pain and swelling. Consider placing ice on the back of the heel to reduce inflammation.
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue
to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you. No matter what
kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive
shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising. Wear comfortable, properly fitting
shoes with good arch support and cushioning. Make sure there is enough room for your toes.