There are two categories of Heel Pain
. pain on the bottom (plantar) and pain on the back of the heel bone
(calcaneus). The most common cause pain on the bottom of the heel is plantar fasciitis or better known as heel spur syndrome. Another common cause is nerve entrapment (~70% of patients have both
plantar fasciitis and nerve entrapment) and less commonly, stress fracture, arthritis, tendonitis, a cyst or a combination of these. Pain on the back of the heel most often involves the insertion of
the Achilles tendon into the bone. Due to the multi-factorial nature of heel pain, the earlier a diagnosis is made, the better the outcome.
The most common cause of heel pain is a pull on the heel bone exerted by the muscles and ligaments (plantar fascia shown in illustration above) that support the arch of the foot. This is an overuse
condition similar to bursitis of the shoulder or tennis elbow. Plantar fasciitis is typically very painful in the morning during the first few steps, after sitting and again at the end of the
Sever?s Disease. This is a condition that occurs in 10 - 15 year old children, predominantly boys and is associated with running and repetitive jumping. It is also associated with flimsy footwear
that kids may wear. It occurs when the Achilles tendon continually pulls on the apophysis of the calcaneum and does not allow for it to fuse with the body of the calcaneum. Calcaneal enthesopathy.
This occurs when there is repetitive trauma at the attachment of the Achilles tendon, resulting in a spur from the calcaneum up into the Achilles tendon. It is usually visualized on x-ray and may be
tender if there is an associated bursitis or tendonitis. "Pump Bump". Also known as Haglund?s Deformity, this is a bony enlargement that exists on the back of the heel - usually related to a
congenital abnormality or with chronic bursitis, causing a thickening. There may have already been trauma or pressure from footwear. Treatment is usually protection of the bump and correct footwear.
Associated with a symmetrical swelling at the base of the Achilles tendon. It is usually related to repetitive trauma or inappropriate footwear. It is often red and hot in the early stages. Treatment
is usually to correct the footwear, provide padding and treat the local symptoms e.g. ice, rest, physiotherapy and cortisone injection. Fat Pad Syndrome. Direct contact with the base of the heel may
result in trauma to the fat pad. Related to obesity, training on hard surfaces, uneven grounds, poor shoes especially overlarge shoes which can cause shearing forces on the heel. These conditions are
renowned for taking a long time to recover - usually many months.
After you have described your foot symptoms, your doctor will want to know more details about your pain, your medical history and lifestyle, including. Whether your pain is worse at specific times of
the day or after specific activities. Any recent injury to the area. Your medical and orthopedic history, especially any history of diabetes, arthritis or injury to your foot or leg. Your age and
occupation. Your recreational activities, including sports and exercise programs. The type of shoes you usually wear, how well they fit, and how frequently you buy a new pair. Your doctor will
examine you, including. An evaluation of your gait. While you are barefoot, your doctor will ask you to stand still and to walk in order to evaluate how your foot moves as you walk. An examination of
your feet. Your doctor may compare your feet for any differences between them. Then your doctor may examine your painful foot for signs of tenderness, swelling, discoloration, muscle weakness and
decreased range of motion. A neurological examination. The nerves and muscles may be evaluated by checking strength, sensation and reflexes. In addition to examining you, your health care
professional may want to examine your shoes. Signs of excessive wear in certain parts of a shoe can provide valuable clues to problems in the way you walk and poor bone alignment. Depending on the
results of your physical examination, you may need foot X-rays or other diagnostic tests.
Non Surgical Treatment
If you have experienced painful heels try wearing your shoes around your house in the evening. Don't wear slippers or socks or go barefoot. You may also try gentle calf stretches for 20 to 30 seconds
on each leg. This is best done barefoot, leaning forward towards a wall with one foot forward and one foot back. If the pain persists longer than one month, you should visit a podiatrist for
evaluation and treatment. Your feet should not hurt, and professional podiatric care may be required to help relieve your discomfort. If you have not exercised in a long time, consult your podiatric
physician before starting a new exercise program. Begin an exercise program slowly. Don't go too far or too fast. Purchase and maintain good shoes and replace them regularly. Stretch each foot and
achilles tendon before and after exercise. Avoid uneven walking surfaces or stepping on rocks as much as possible. Avoid going barefoot on hard surfaces. Vary the incline on a treadmill during
exercise. Nobody walks uphill all the time. If it hurts, stop. Don't try to "work through the pain." Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis
and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin,
and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.
Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on
several areas, remove the bone spur (if one is present), release the plantar fascia (plantar fasciotomy), release pressure on the small nerves in the area. Usually the procedure is done through a
small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under
the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal
tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision. Surgery usually involves identifying the area where the plantar fascia
attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released
from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.
Wear properly fitting shoes. Place insoles or inserts in your shoes to help control abnormal foot motion. Maintain a healthy weight. Exercise and do foot stretches as they have been shown to decrease
the incidence of heel pain.