Stacy A. Bacon, MD - Orthopaedic Surgeon
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Heel Pain

Heel PainEvery mile you walk puts tons of stress on each foot. Your feet can handle a heavy load, but too much stress pushes them over their limits. When you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues, you may develop Heel pain, the most common problem affecting the foot and ankle. A sore Heel will usually get better on its own without surgery if you give it enough rest. However, many people try to ignore the early signs of Heel pain and keep on doing the activities that caused it. When you continue to walk on a sore Heel, it will only get worse and could become a chronic condition leading to more problems.Surgery is rarely necessary.

Evaluation and Treatment

Heel pain can have many causes. If your Heel hurts, see your doctor right away to determine why and get treatment. Tell him or her exactly where you have pain and how long you've had it. Your doctor will examine your Heel, looking and feeling for signs of tenderness and swelling. You may be asked to walk, stand on one foot or do other physical tests that help your doctor pinpoint the cause of your sore Heel. Conditions that cause Heel pain generally fall into two main categories: pain beneath the Heel and pain behind the Heel.

Pain Beneath the Heel

If it hurts under your Heel, you may have one or more conditions that inflame the tissues on the bottom of your foot

  • Stone Bruise: When you step on a hard object such as a rock or stone, you can bruise the fat pad on the underside of your Heel. It may or may not look discolored. The pain goes away gradually with rest

  • Plantar Fasciitis (Subcalcaneal Pain): Doing too much running or jumping can inflame the tissue band (fascia) connecting the Heel bone to the base of the toes. The pain is centered under your Heel and may be mild at first but flares up when you take your first steps after resting overnight. You may need to do special exercises, take medication to reduce swelling and wear a Heel pad in your shoe

  • Heel Spur: When plantar fasciitis continues for a long time, a Heel spur (calcium deposit) may form where the fascia tissue band connects to your Heel bone. Your doctor may take an X-ray to see the bony protrusion, which can vary in size. Treatment is usually the same as for plantar fasciitis: rest until the pain subsides, do special stretching exercises and wear Heel pad shoe inserts. Having a Heel spur may not cause pain and should not be operated on except if symptoms become chronic

Plantar Fasciitis

Plantar Fasciitis - inflammation in the sole of the foot.

Who gets it? Everyone. People who are active either at work, home, or athletically are more likely to get plantar fasciitis. It is common in runners and walker and in people who stand for prolonged periods of time.

Pain is located in the arch near the Heel. It is worse in the morning when you get out of bed as well as after prolonged sitting.

The cause of plantar fasciitis is usually related to a tight calf muscle. There is a misconception that the pain is a result of a Heel spur. A spur may form but it is as a reaction to the inflammation in the plantar fascia and is not the cause of the pain.

Treatment

Calf stretch, silicone Heel cups, ice, night splint, physical therapy. Sometimes custom orthotics are beneficial in long standing cases. Steroid injections have been used and although they temporarily relieve the pain, the pain usually returns within a short period of time.

Plantar fasciitis tends to go away in 90% of all people in time. It can take 12-18 months for all the pain to resolve. If the pain continues after adequate treatment, high frequency shock wave therapy (OssaTron) has been found to be beneficial, unfortunately most insurance companies do not cover this procedure.

Achilles Tendonitis

Achilles tendonitis - inflammation of the Achilles tendon or "Heel Cord".

Pain is located in the back of the Heel. It is worse in the morning when you get out of bed as well as after prolonged sitting.

Who gets it? Usually runners or avid walkers. Some people get Heel bursitis which is similar to achilles tendonitis but is usually not activity related. Heel bursitis is usually caused by a prominent Heel bone or Haglunds deformity. Regardless of tendonitis or bursitis, the underlying problem is a tight calf muscle.

Treatment

Calf stretch, Heel cups/lifts, ice, night splint, physical therapy, activity modification. Sometimes immobilization in a cast or boot may be necessary. Topical creams, such as Voltaren or Ketoprofen, have been found to have some benefit.

In some cases, the tendon may become degenerative (tendonosis). In these instances, treatment is more difficult. Prolonged periods of immobilization and physical therapy may be required. In resistant cases, surgical debridement of the tendon may be necessary.

Rarely does a symptomatic achilles tendon rupture. Most achilles ruptures are not associated with prodromal symptoms. Achilles ruptures are more common in men and "weekend warriors," ie middle aged men who like to play sports (soccer, softball, basketball) on the weekends.

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Stacy A. Bacon, MD - Orthopaedic Surgeon Advanced Orthopaedics Sports Medicine