Heel pain is one of the most common conditions treated by podiatrists. It is often a message that something is in need of medical attention. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we have suffered. Heel pain is a problem which affects people of all ages and vocations, whether they are active or not and it comes in many different forms. Heel pain can also occur in children usually between the ages of 8 and 13, as they become increasingly active in sporting activities and during the growing phase.
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.
Pain typically comes on gradually, with no injury to the affected area. It is frequently triggered by wearing a flat shoe, such as flip-flop sandals. Flat footwear may stretch the plantar fascia to such an extent that the area becomes swollen (inflamed). In most cases, the pain is under the foot, toward the front of the heel. Post-static dyskinesia (pain after rest) symptoms tend to be worse just after getting out of bed in the morning, and after a period of rest during the day. After a bit of activity symptoms often improve a bit. However, they may worsen again toward the end of the day.
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
Treatments to add to your stretching program include wearing good-quality shoes, icing the painful area, and massaging the arch. Do not walk barefoot; walk in shoes with good heel and arch supports such as high-quality walking or running shoes. Keep a pair of shoes next to your bed so you can put them on before taking your first step. Your doctor may recommend that you wear an additional arch support or a heel cup in the shoes. Icing your foot can help relieve pain. Rub a frozen bottle of water or an ice cup over the tender areas for five minutes two times each day. Massage your foot by rolling a tennis, golf ball, or baseball along your sole and heel. This friction massage can help break up adhesions and stretch the plantar fascia. Do this for five minutes two times each day. If you are a runner or just started a walking or running program, evaluate your training for errors such as warming up improperly, increasing mileage too quickly, running hills excessively, running on surfaces that are too hard, or wearing broken down shoes. Adjusting your training program can help relieve your pain. While recovering from heel pain, walk or jog in a pool or crosstrain by biking and swimming. These activities maintain your cardiovascular fitness without stressing your heel cord or plantar fascia. Heel pain takes time to go away. Be patient and remember that no treatment is a substitute for STRETCHING!
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.
heel pads shoes too big
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.