Topics > Ankle > Heel Pain
Heel Pain
The heel is the largest bone in the foot. Heel pain is the most common
foot problem and affects 2 million Americans every year. It can occur
in the front, back, or bottom of the heel. A sore heel will usually get
better on its own without surgery if given enough rest. However, many
people try to ignore the early signs of heel pain and keep on doing the
activities that caused it. When you continue to use a sore heel, it will
only get worse and could become a chronic condition worsening the problems.
Surgery is rarely necessary.
Heel pain can have many causes. If you have
heel pain, you should consult your doctor. Conditions that cause heel
pain generally
fall into two main
categories: pain beneath the heel and pain behind the heel.
Pain beneath the heel
If it hurts under your heel, you may have one or
more conditions that inflame the tissues on the bottom of your foot:
- Stone bruise: When you step on
a hard object such as a rock or stone, you can bruise the fat pad
on the underside of your heel. It may or may
not
look discolored. The pain goes away gradually with rest.
- Plantar fasciitis
(subcalcaneal pain): Extensive running or jumping can inflame the
tissue band (fascia) connecting the heel bone to the base
of
the toes. The pain is centered under your heel and may be mild at
first but flares up when you take your first steps after resting overnight.
You may need to do special exercises, take medication to reduce swelling
and
wear a heel pad in your shoe.
- Heel spur: When plantar fasciitis continues
for a long time, a heel spur (calcium deposit) may form where the
fascia tissue band connects to
your
heel bone. As a spur develops, the soft tissue in the heel becomes
irritated and swells, putting pressure on the nerves and causing pain.
Pain may
increase with age as the fatty tissue on the bottom of the foot wears
away. They
often result from improper foot movement during running or walking,
poorly-fitting shoes, and excessive body weight. Insoles and non-steroidal
anti-inflammatory
drugs (NSAIDs) such as aspirin or ibuprofen (Advil) may be sufficient
to relieve the pain. If the pain
persists, surgery that involves cutting and releasing the plantar
fascia and removing the spurs may be recommended. Recovery usually
requires
immobilization of the foot and use of crutches for about two weeks.
Surgery should be a last resort.
Pain behind the heel
Pain behind the heel may be caused by overuse injury
to Achilles tendon which inserts into the heel bone (retrocalcaneal
bursitis). It is often
caused by extensive running or wearing shoes that rub or cut
into the back of the heel. Pain may build slowly over time, causing
the skin to thicken, get red and swell. Over time a tender bump on the
back
of your heel may develop. The pain flares up when you first start an
activity after resting. It often hurts too much to wear normal shoes.
Treatment
includes resting from the activities that caused the problem, doing
certain stretching exercises, using pain medication and wearing
open back shoes.
- A 3/8" or 1/2" heel insert may help.
- Stretching the Achilles
tendon by leaning forward against a wall with your foot flat on
the floor and heel elevated with the insert may
help.
- Non-steroidal
anti-inflammatory medications (i.e. Advil) may help pain and swelling.
- Ice on the back of the heel will reduce inflammation.
General treatment guidelines:
- The American Orthopaedic Foot and Ankle
Society (AOFAS) suggests shoe inserts, medications, and stretching
as a first line of therapy for
heel
pain. One study found that 95% of women who used an insert and
did simple stretching exercises for the Achilles tendon and plantar
fascia
experienced
improvement after 8 weeks.
- If these treatments fail, the patient may
need prescription heel orthotics and extended physical therapy.
- Heel surgery to relieve pain may be performed
for heel spurs, plantar fasciitis, bursitis, or neuroma.
- Surgery is not recommended until nonsurgical
methods have failed for at least six months and preferably up to
12 months. Nonsurgical treatments
for heel pain are effective in 90% of patients.
Reducing Pressure on
the Heel
- Wearing comfortable shoes with thick soles
and rubber heels and wearing a sole insole relieves pressure. Cutting
a round hole about the size
of a quarter in the sole cushion under the painful area may help
support to the rest of the heel while relieving pressure on the painful
spot
itself. When combined with exercises that stretch the arch and
heel cord, over-the-counter insoles may offer the same relief as prescribed
orthotics.
- Night
Splints. There is some evidence that splints worn at night may
be helpful for some people. One device uses an Ace bandage and an L-shaped
fiberglass splint, which the patient wears while sleeping; it keeps
the foot stretched, allowing the muscle to heal.
Excessive Pronation
Pronation is the normal motion that allows the foot
to adapt to uneven walking surfaces and to absorb shock. Excessive
pronation occurs when
the foot has a tendency to turn inward and stretch and pull the fascia.
It can cause not only heel pain, but also hip, knee, and lower back problems.
