Your foot is made up of 26 bones, 33 joints, and more than 100 tendons. The heel is the largest bone in your foot. If you overuse or injure your heel, you may experience Heel Pain
. This can range from mild to disabling. In many cases, if you have heel pain, you
will need a doctor to diagnose the cause.
A sharp stabbing pain, like a nail going into the bottom of the heel when first stepping on the foot after getting out of bed or after sitting for period of time, is the most common description for
plantar fasciitis or heel spur syndrome. Typically the pain eases off as the day goes on but it may not go away completely. A thick ligament that attaches to the bottom of the heel and runs the
length of the foot to the toes can become inflamed and swollen at the attachment site. This tends to be an overuse type of injury where poor foot structure is involved; also, wearing of shoe gear
that lacks adequate support (ie: worn out shoes, boots and flip-flops) and prolonged standing or walking are often implicated. A throbbing pain that gets worse as the day goes on and can be worse at
night when laying in bed is most often associated with an irritated or entrapped nerve on the inside of the ankle or heel. This is similar to carpel tunnel syndrome in the wrist and hand.
Approximately 7 / 10 patients with heel pain have a component of nerve entrapment as the cause of their heel pain. This is also one of the most common causes of chronic heel pain because it is often
missed as a diagnosis. When nerve entrapment is considered to be a cause, painless neurosensory testing is performed with the Pressure Specified Sensory Device? (PSSD) at The Foot & Ankle Center,
PC to determine the extent of compression. A less common cause of heel pain but a stress fracture is often considered in athletes, such as long distance runners, who have heel pain. Posterior Heel
Pain (Retrocalcaneal) This is pain in the back of the heel that flares up when first starting an activity. It is often associated with a large bump that can be irritated by shoes. The Achilles tendon
attaches to the back of the heel and, like on the bottom, this attachment site can often become inflamed; a spur may or may not be present. Another painful area is a sac of fluid (bursa) that sits
between the tendon and bone to act as a cushion for the tendon. This bursa can become inflamed often leading to significant pain called retrocalcaneal bursitis.
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.
In most cases, your GP or a podiatrist (a specialist in foot problems and foot care) should be able to diagnose the cause of your heel pain by asking about your symptoms and medical history,
examining your heel and foot.
Non Surgical Treatment
Treatment of heel pain depends on its cause. Plantar fasciitis. Most doctors recommend a six- to eight-week program of conservative treatment, including temporary rest from sports that trigger the
foot problem, stretching exercises, ice massage to the sole of the foot, footwear modifications, taping of the sole of the injured foot, and acetaminophen (Tylenol) or nonsteroidal anti-inflammatory
drugs (NSAIDs), such as aspirin or ibuprofen (Advil, Motrin and others) for pain. If this conservative treatment doesn't help, your doctor may recommend that you wear a night splint or a short leg
cast, or he or she may inject corticosteroid medication into the painful area. Surgery is rarely necessary and is not always successful. Heel spur. Conservative treatment includes the use of shoe
supports (either a heel raise or a donut-shaped heel cushion) and a limited number of local corticosteroid injections (usually up to three per year). As in plantar fasciitis, surgery is a last
resort. Calcaneal apophysitis. This condition usually goes away on its own. In the meantime, conservative treatment includes rest and the use of heel pads and heel cushions. Bursitis. Treatment is
similar to the treatment of heel spurs. Changing the type of footwear may be essential.
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).
Before you get out of bed in the morning, and then periodically throughout the day, do the following exercises to increase flexibility and ease pain. Slowly flex your foot and toes to stretch the
tissue on the bottom of your sore foot. Hold the stretch for 10 counts. Relax and repeat. Do gentle ankle rolls to keep the tissues around the ankle and on the back of the heel flexible. Sit on the
edge of your bed and roll your foot back and forth over a tennis ball.