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Understanding Heel Pain

by Dr. Damon Hays  |  November 4, 2009

In my practice, I’ve found that heel pain is one of the most common foot complaints reported by my patients. It’s no surprise, considering that the heel is required to bear a great deal of our weight when we walk. In fact, a normal healthy adult puts over 50 tons of stress on each foot for every mile that he or she walks. That amount of stress is greatly multiplied when we run or jump, even in the course of normal exercise. Further, many people have simply developed incorrect methods of walking, which can over time create various forms of heel injury, or may have chosen footwear that is either inappropriate for their particular needs or is poorly constructed.

Heel pain generally develops as a result of overstress on the heel bone – the largest of the bones found in the foot – and the soft tissues that surround it. Sometimes heel pain can be effectively treated with rest and basic podiatric care if caught early enough. However, if heel pain is ignored for too long, it can develop into more serious conditions that require more intensive treatments.

Plantar fasciitis is one of the most common conditions that causes heel pain in my patients. The plantar fascia is a narrow band of connective tissue that runs from right behind the toes on the ball of the foot to the heel bone. If that tissue becomes consistently overextended – often as the result of running or other athletic activity – it can become irritated, resulting in pain, and, sometimes, the development of a heel spur. Many people with plantar fasciitis report waking up in the morning and feeling as if the bottom side of their foot is “tight” or “stretched.” Throughout the day, this sensation may lessen, but it will almost definitely return after any extended period of nonuse.

Heel spurs are bony protrusions that develop on the underside of the heel bone. When the plantar fascia is overextended, it can actually tear away the membrane that covers the heel bone. This can stimulate the growth of a heel spur, which can add to the discomfort of patients with plantar fasciitis. Sometimes, however, heel spurs can develop without the co-occurrence of plantar fasciitis, simply because of repeated abuse to the heel bone, as well as the muscles and ligaments that surround it.

But there are several other potential causes for your heel pain. You may simply have bruised the bone, which can happen if you step barefoot onto a stone or other hard, protruding object. Or, you may be experiencing heel pain as the result of the inflammation of your Achilles tendon, which can occur as the result of an active, athletic lifestyle. Bursitis, arthritis, and many other conditions can also make your heels painful.

The important thing to know is that heel pain doesn’t have to dictate your life or lifestyle. Podiatrists have become very effective at treating heel pain, and there are several ways that I can help you understand why your feet feel the way that they do, and what your treatment options are.

On your first visit, you can expect a full examination of your feet, which may include an x-ray and a biomechanical assessment, where I will determine whether your walking gait requires orthotic correction by means of a customized device that is designed to be slipped into the shoe. I will also talk to you about the shoes you wear, and teach you how to select the shoe that is best for you.

If your condition is not severe, your treatment may require nothing more than the administration of an injected or oral anti-inflammatory medication. Additionally, a foot strap may be fitted to you in order to relieve the over-extension of the plantar fascia.

If your condition is sufficiently severe that surgical treatment may be necessary, I will carefully and thoroughly explain your options, and work with you to develop a treatment plan that takes into consideration your lifestyle, your preferences, and your particular needs.

In the meantime, though, there are several things that you can do to prevent or alleviate the early stages of foot pain. First, you can remember to respect your feet. Make sure that your shoes fit correctly, and that they support your arches and cushion your heels. If you’re engaging in activity that is causing foot or heel pain, such as a new exercise regimen, remember to start slowly, and to stretch your feet and ankles thoroughly before launching into anything strenuous. And, most importantly, if you experience severe pain, contact a podiatrist before it worsens.

Source: American Podiatric Medical Association

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