Heel pain is a common foot condition. It's usually felt as an intense pain when using the affected heel. Heel Pain usually builds up gradually and gets worse over time. The pain is often severe and occurs when you place weight on the heel. In most cases, only one heel is affected, although estimates suggest that around a third of people have pain in both heels. The pain is usually worse first thing in the morning, or when you first take a step after a period of inactivity. Walking usually improves the pain, but it often gets worse again after walking or standing for a long time. Some people may limp or develop an abnormal walking style as they try to avoid placing weight on the affected heel.
There is no one cause of heel pain. Whole text books have been written on Disorders of the Heel. Some of the types of problems that can be seen in the heel include Heel spurs, these are small bony spurs that often develop on the bottom of the heel. They do not really cause any problems. It is only mentioned here as it is a common myth that they are a problem - almost always the pain associated with heel spurs is really plantar fasciitis. Plantar fasciitis is the most common cause of heel pain and is due to a strain of the long ligament along the bottom of the foot. The most symptom is pain when getting out of bed first thing in the morning ('post-static dyskinesia') A number of disease processes can uncommonly cause heel pain, such as rheumatoid arthritis, ankylosing spondylitis and gout. Stress fractures, which is an abnormal reaction of bone to stress can occur in those that are very active (eg athletes) or have weaker bones (eg osteoporosis) Pain at the back of the heel could be due to a number of problems, there could be a bursitis at the back of the heel bone (sometimes called 'Haglund's) there could be problems with the insertion of the achilles tendon, such as tendonitis or calcification. A 'stone' bruise is sometimes considered to be a cause of heel pain, its is simply a bruise of the bone. Another cause of heel pain is problems in the calf muscles that refer pain to the heel (myofascial trigger points) or pain referred from the lower back via the nerves from the back to the heel. Heel pain in children is usually due to severs disease or calcaneal apophysitis.
Initially, this pain may only be present when first standing up after sleeping or sitting. As you walk around, the muscle and tendon loosen and the pain goes away. As this problem progresses, the pain can be present with all standing and walking. You may notice a knot or bump on the back of the heel. Swelling may develop. In some cases, pressure from the back of the shoe causes pain.
Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot - this could be a sign of nerve damage in your feet and legs (peripheral neuropathy), your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection, you have stiffness and swelling in your heel - this could be a sign of arthritis. Possible further tests may include, blood tests, X-rays - where small doses of radiation are used to detect problems with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.
Non Surgical Treatment
Depending on the underlying cause, treatment can include. Rest from activities that stress the heel (such as running and jumping). Ice packs. Regular foot massage, concentrating on the arch of the foot. Professional strapping. A splint worn at night. Flexibility exercises. Ultrasound therapy. Anti-inflammatory medicine (topical or oral). Checking your posture and walking style, to correct imbalances and gait abnormalities that may contribute to the pain. Shoe inserts (orthoses) to help support the foot. In some cases, surgery may be recommended to treat conditions including neuroma, bursitis and heel spurs.
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you. No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
The following steps will help prevent plantar fasciitis or help keep the condition from getting worse if you already have it. The primary treatment is rest. Cold packs application to the area for 20 minutes several times a day or after activities give some relief. Over-the-counter pain medications can help manage the pain, consult your healthcare professional. Shoes should be well cushioned, especially in the midsole area, and should have the appropriate arch support. Some will benefit from an orthotic shoe insert, such as a rubber heel pad for cushioning. Orthotics should be used in both shoes, even if only one foot hurts. Going barefoot or wearing slipper puts stress on your feet. Put on supportive shoes as soon as you get out of bed. Calf stretches and stretches using a towel (place the towel under the ball of your feet and pull gently the towel toward you and hold a few seconds) several times a day, especially when first getting up in the morning. Stretching the Achilles tendon at the back of the heel is especially important before sports, but it is helpful for nonathletes as well. Increasing your exercise levels gradually. Staying at a healthy weight. Surgery is very rarely required.