Heel pain is often a symptom caused by one of two conditions: Plantar Fasciitis or Achilles Tendonitis. Most commonly, heel pain experienced at the bottom of the heel is caused by plantar fasciitis.
may become so severe for some that just putting weight on their feet first
thing in the morning is excruciating. Walking or running may feel completely out of the question.
Some of the many causes of heel pain can include abnormal walking style (gait), such as rolling the feet inwards. Obesity. Ill-fitting shoes. Standing, running or jumping on hard surfaces. Injury to
the heel, such as stress fractures. Bursitis (inflammation of a bursa, bursae are small sacs that contain fluid to lubricate moving parts, such as joints and muscles). Neuroma (nerve enlargement).
Certain disorders, including diabetes and arthritis.
Initially, this pain may only be present when first standing up after sleeping or sitting. As you walk around, the muscle and tendon loosen and the pain goes away. As this problem progresses, the
pain can be present with all standing and walking. You may notice a knot or bump on the back of the heel. Swelling may develop. In some cases, pressure from the back of the shoe causes pain.
A podiatrist (doctor who specializes in the evaluation and treatment of foot diseases) will carry out a physical examination, and ask pertinent questions about the pain. The doctor will also ask the
patient how much walking and standing the patient does, what type of footwear is worn, and details of the his/her medical history. Often this is enough to make a diagnosis. Sometimes further
diagnostic tests are needed, such as blood tests and imaging scans.
Non Surgical Treatment
Treatment options for plantar fasciitis include custom prescription foot orthoses (orthotics), weight loss when indicated, steroid injections and physical therapy to decrease the inflammation,
night-splints and/or cast boots to splint and limit the stress on the plantar fascia. Orthotripsy (high frequency ultra-sonic shock waves) is also a new treatment option that has been shown to
decrease the pain significantly in 50 to 85 percent of patients in published studies. Surgery, which can be done endoscopically, is usually not needed for over 90 percent of the cases of plantar
fasciitis. (However, when surgery is needed, it is about 85 percent successful.) Patients who are overweight do not seem to benefit as much from surgery. Generally, plantar fasciitis is a condition
people learn to control. There are a few conditions similar to plantar fascia in which patients should be aware. The most common is a rupture of the plantar fascia: the patient continues to exercise
despite the symptoms and experiences a sudden sharp pain on the bottom of the heel and cannot stand on his or her toes, resulting in bruising in the arch. Ruptures are treated very successfully by
immobilization in a cast boot for two to six weeks, a period of active rest and physical therapy. Another problem with prolonged and neglected plantar fasciitis is development of a stress fracture
from the constant traction of this ligament on the heel bone. This appears more common in osteoporotic women, and is also treated with cast boot immobilization. The nerves that run along the heel
occasionally become inflamed by the subsequent thickening and inflammation of the adjacent plantar fascia. These symptoms often feel like numbness and burning and usually resolve with physical
therapy and injections. Patients should also be aware that heel numbness can be the first sign of a back problem.
Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver
high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a
"numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National
Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are
uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies
found the procedure to be no better than a placebo (sham treatment).
The following steps will help prevent plantar fasciitis or help keep the condition from getting worse if you already have it. The primary treatment is rest. Cold packs application to the area for 20
minutes several times a day or after activities give some relief. Over-the-counter pain medications can help manage the pain, consult your healthcare professional. Shoes should be well cushioned,
especially in the midsole area, and should have the appropriate arch support. Some will benefit from an orthotic shoe insert, such as a rubber heel pad for cushioning. Orthotics should be used in
both shoes, even if only one foot hurts. Going barefoot or wearing slipper puts stress on your feet. Put on supportive shoes as soon as you get out of bed. Calf stretches and stretches using a towel
(place the towel under the ball of your feet and pull gently the towel toward you and hold a few seconds) several times a day, especially when first getting up in the morning. Stretching the Achilles
tendon at the back of the heel is especially important before sports, but it is helpful for nonathletes as well. Increasing your exercise levels gradually. Staying at a healthy weight. Surgery is
very rarely required.