Overview
Heel pain is a very challenging problem as it can be local and/or referred. It has been more prevalent recently due to the hard grounds on which people have to run. Commonly people will present with heel pain, thrusting an x-ray at you, and being adamant that the problem is a ?heel spur?. This is defined as a small bone that grows from the heel, directing forwards towards the toes. This may be as small as 1 mm to anything as large as 8 - 10 mm. Most of the time, this is an incidental finding, as there many heels that are pain free that have heel spurs evident on x-rays. The spur is thought to be a result of traction of the plantar fascia on the heel. In some cases, the spur may contribute to the symptoms, but is not the main cause. This should be explained very carefully to the patient, as the focus on the spur may limit the recovery, as the patient may believe that the only way to eliminate the pain is to remove the spur.
Causes
As stated above, if biomechanical complaints such as over pronation exist during running then this can lead to planter fascitis and heel pain. Over pronation occurs when there is excessive mobility in the sab-taler joint of the foot which causes hyper mobility of the foot. Conditions such as flat feet can also cause over pronation. This increased mobility adversely affects all the muscles in the foot and can even affect the lower leg, upper leg and cause back pain. The mechanical imbalance is highlighted during running due to the increased forces being applied to the body Runners often complain that the pain increases when they enter the toe off phase of the running cycle as this stretches the muscle away from the heel bone. Apart from over pronation, other causes of planter fascitis are a change of running shoes, dramatic increases in speed work, hill work and mileage.
Symptoms
Pain in the heel can be caused by many things. The commonest cause is plantar fascitis. Other causes include, being overweight, constantly being on your feet, especially on a hard surface like concrete and wearing hard-soled footwear, thinning or weakness of the fat pads of the heel, injury to the bones or padding of the heel, arthritis in the ankle or heel (subtalar) joint, irritation of the nerves on the inner or outer sides of the heel, fracture of the heel bone (calcaneum).
Diagnosis
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
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.
Surgical Treatment
When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.
Why do I have pain in my heel?
Prevention
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.
Heel pain is a very challenging problem as it can be local and/or referred. It has been more prevalent recently due to the hard grounds on which people have to run. Commonly people will present with heel pain, thrusting an x-ray at you, and being adamant that the problem is a ?heel spur?. This is defined as a small bone that grows from the heel, directing forwards towards the toes. This may be as small as 1 mm to anything as large as 8 - 10 mm. Most of the time, this is an incidental finding, as there many heels that are pain free that have heel spurs evident on x-rays. The spur is thought to be a result of traction of the plantar fascia on the heel. In some cases, the spur may contribute to the symptoms, but is not the main cause. This should be explained very carefully to the patient, as the focus on the spur may limit the recovery, as the patient may believe that the only way to eliminate the pain is to remove the spur.
Causes
As stated above, if biomechanical complaints such as over pronation exist during running then this can lead to planter fascitis and heel pain. Over pronation occurs when there is excessive mobility in the sab-taler joint of the foot which causes hyper mobility of the foot. Conditions such as flat feet can also cause over pronation. This increased mobility adversely affects all the muscles in the foot and can even affect the lower leg, upper leg and cause back pain. The mechanical imbalance is highlighted during running due to the increased forces being applied to the body Runners often complain that the pain increases when they enter the toe off phase of the running cycle as this stretches the muscle away from the heel bone. Apart from over pronation, other causes of planter fascitis are a change of running shoes, dramatic increases in speed work, hill work and mileage.
Symptoms
Pain in the heel can be caused by many things. The commonest cause is plantar fascitis. Other causes include, being overweight, constantly being on your feet, especially on a hard surface like concrete and wearing hard-soled footwear, thinning or weakness of the fat pads of the heel, injury to the bones or padding of the heel, arthritis in the ankle or heel (subtalar) joint, irritation of the nerves on the inner or outer sides of the heel, fracture of the heel bone (calcaneum).
Diagnosis
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
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.
Surgical Treatment
When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.
Why do I have pain in my heel?
Prevention
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.