Heel pain can occur on either the back, bottom or both, of the heel. When occurring on the back of the heel the condition may be caused by the shape of the heel bone and is known as Haglund’s deformity and can be related to the Achilles tendon. When on the bottom of the heel it is most often caused by plantar fasciitis, also known as heel spur syndrome if a spur is also present. Other causes of heel pain are known such as referred nerve pain or irritation, a stress fracture, tendonitis, arthritis, or a cyst.
Because there are several potential causes, it is important to have heel pain properly diagnosed. A Doctor at Weil Foot & Ankle Institute can distinguish between all the possibilities and determine the underlying source of your heel pain.
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the tissue is first injured and with activity becomes inflamed resulting in heel pain.
What is Haglund’s deformity?
Haglund’s deformity is the present of a large bump on the back of the heel that rubs against the shoe causing pain. It may also rub against the Achilles tendon causing irritation and damage. It is usually associated with a spur that will also rub against the shoe sand tendon causing further damage.
The most common cause of plantar fasciitis relates to faulty structure and stability of the foot. Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciitis. Weight, age and activity are all associated with the development of this condition.
Nerve injury, often associated with plantar fasciitis, either coming from the back or found from a damaged nerve on the foot, is seen frequently. Complicating the examination this condition can be hard to detect and when suspected electrodiagnostic nerve tests are required to confirm the presence of nerve injury and its location and degree.
The symptoms of plantar fasciitis are:
- Pain on the bottom of the heel
- Pain on the bottom of the heel
- Pain that is usually worse upon arising
- Pain that increases over a period of months
- Pain in bed or at rest
People with plantar fasciitis often describe the pain as worse when they get up in the morning or with activity after they have been sitting for long periods of time. After a few minutes of walking, the pain decreases. For some people, the pain subsides but returns after spending long periods of time on their feet.
Treatment of plantar fasciitis begins with first-line strategies that support the foot.
- Stretching exercises. Exercises that stretch out the calf muscles help ease pain and speed recovery.
- Avoid going barefoot. When you walk barefoot or use non-supportive slippers or sandals you place undue strain and stress on your plantar fascia resulting in injury
- Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.
- Limit activities. Cut down on extended physical activities to give your heel a rest.
- Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
- Medications. Oral non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are recommended to reduce pain and inflammation.
If you still have pain after several weeks, see a foot and ankle Doctor at Weil Foot & Ankle Institute, who will add further treatment options:
- Padding and strapping. Placing pads on the foot or in the shoe and softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
- Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis while being comfortable and providing long term use.
- Injection therapy. In some cases, corticosteroid injections and OrthoBiologics are used to help reduce the inflammation and relieve pain.
- Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
- Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This will help reduce the morning pain experienced by some patients.
- Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients 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.
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