Heel Pain (Plantar Fasciitis)

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Avoiding Heel Pain

With 26 bones, 33 joints and more than 100 muscles, ligaments and tendons networked together in the human foot, the heel bone is the largest. As with all other bones, there are always outside factors that will determine the heelís integrity and its capacity to keep us standing on our feet. Pain in the heel, whether it is focused in the back, front or the bottom of the heel is sometimes disabling.

Causes of Heel Pain

heel-painThere are many different possible causes for heel pain. It is usually because the biomechanics of the personís walking are flawed. In other words, there is an abnormality of the gait when the person walks. This will place unusual stress on the bone in the heel and its attached soft tissues. Sometimes this extra stress is a result of having suffered an injury or, possibly, it was bruised while running, walking or jumping on surfaces that are hard. It can also happen because of shoes that are not made well, such as flip-flops which are flimsy or it can be because the person is overweight.

Most commonly, heel pain is caused by:

Heel Spurs: This is a growth on the bottom of the heel bone that is bony. It can be seen on an X-ray and looks like a protrusion that sometimes can be as long as a half-inch. If the doctor cannot see any problem with actual enlargement of the bone, the problem is usually called ìheel spur syndrome.î Generally, heel spurs are a result of undue strain on the ligaments and muscles of the foot. Because of the strain, the long band of tissue connecting the ball of the foot and the heel is stretched. The membrane, or lining, that is covering the heel bone is usually torn away from bone over and over again.

Plantar Fasciitis: This can cause both heel spurs and heel pain, which is a swelling of the fibrous connective tissue, also known as the fascia, band which goes along the bottom part of the foot from the ball of the foot to the heel. This bottom part of the foot is known as the plantar surface. This injury is frequently seen in athletes who jump and run a lot and it is often very painful.

Usually, this problem appears when the plantar fascia experiences straining, more than is normal, over a period of time. This will cause the soft tissue fibers of the fascia to stretch or tear at various places along its length.

This often leads to pain, inflammation and sometimes a bone spur will grow at the point where the plantar fascia is attached to the heel bone. This swelling is often made worse if the person wears shoes that do not give adequate support, especially in the arch. It is also aggravated by the continuing irritation that is sometimes found among people who have an active, athletic lifestyle.

You will probably only get relief on a temporary basis from resting. As soon as you begin walking again, in particular if itís after a nightís sleep, there will usually be another elongation of the fascia and this will pull and stretch on the heel. After walking for a little while, the pain may be less or even go away entirely, but that is probably just a temporary relief. Unfortunately, the pain will usually come back after a lengthy rest or a lot of walking.

Excessive Pronation: This is heel pain that is because of excessive pronation. The flexing and flattening of the footís arch is called pronation. This movement lets the foot absorb shock and adjust for differences in ground surface in normal walking.

Achilles tendinitis: This is pain that is found at the back of the heel where the Achilles tendon is located. Achilles tendinitis is a swelling of this tendon which goes behind the ankle and is anchored on the heel boneís back surface. This is not unusual for people who walk or run a lot with tight tendons. If this tendon is strained for a long time, its fibers will stretch or tear along its length or at the point where it is inserted into the heel bone.

This usually causes pain, inflammation and possibly the appearance of a bone spur on the back side of the heel bone. This swelling is often made worse with a lifestyle that is active and especially if the person is straining a tendon that is already tight.

There are other possible causes of pain in the heel, including:

* Arthritis, including rheumatoid arthritis and gout. This most often appears in the joint of the big toe;

* A bursa which is swollen, called bursitis. This is a little, irritated bag of fluid or a neuroma, which is a nerve growth. It may also be another type of growth of the soft tissue. In this case, the pain in the heel may be because of an actual heel spur or it may just give the same pain;

* It may be a contusion or bruise on the bone which has irritated the tissues covering the heel bone. A bruise of the bone can be a very painful injury that is caused by a hard surface or object directly hitting the foot.

When is it Time to Visit a Podiatrist?

If you are experiencing soreness and other symptoms of irritation, swelling, redness or the area feels warm and these symptoms last, you should curtail your usual daily activities and call a doctor of podiatric medicine.

Diagnosis and Treatment

A podiatric doctor will give an examination of the area and might order diagnostic X-rays to make sure there are no problems with the bone itself.

Initial treatments often include injectable or oral anti-inflammatory medicine, changes in recommendations for shoes and exercise, strapping or taping and/or the use of inserts or orthotics in the shoes. The benefit of strapping or taping is that it will support the foot and put the tendons and muscles that have been stressed into a restful place. Along with these treatments, the doctor may also recommend physical therapy.

If it is necessary to correct a biomechanical imbalance, a functional orthotic might be prescribed. This will help control too much pronation and support the tendons and ligaments that attach to the heel bone. It will usually treat arch and heel pain without forcing the patient to go through surgery.

Very few heel pain cases will go on to need treatments that are more advanced or surgery. If it turns out that surgery is required, it might be to release the plantar fascia, remove a spur or bursa, or eliminate a neuroma or another soft tissue growth.


There are several steps that a person can take to keep from developing heel pain and its attendant problems:

* Always wear well-fitting shoes. They should fit at the sides, back and front and have soles that are shock absorbent. This also should have shanks that are rigid and heel counters that are supportive.

* Always wear shoes that are suited to the activity you are doing

* Donít ever wear shoes that are showing a lot of wear on the soles or the heels

* Always warm up properly before exercising. Make sure to stretch both before and after running

* When taking part in athletic activities always pace yourself

* Keep in mind the needs your body has for effective nutrition and rest

* Make sure to lose weight if you are obese

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Dr. Gregory M. Jansyn

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