The heel is one of those body parts we never give much thought to until it begins to hurt. Once we have issues with a painful heel, it very hard to think about anything else. When the bottom of our heels hurt, it affects the way we stand and the way we walk. Heel pain can affect our posture and have repercussions in almost any part of our body. While most of us have grown up fully understanding the usefulness of feet, few of us realize how critical the unappreciated our heels are to our overall well-being.
The foot is a complex part of the human body. Each foot is made up of 26 bones, 33 joints, and more than 100 ligaments. The heel bone, known as the calcaneus, is the largest bone in the foot and is responsible for absorbing much of the walking and running impact of everyday life. While many ligaments and tendons hold the foot’s bones together in ways that maintain the arch, the Achilles tendon and the plantar fascia are the most well-known tendons, and also the ones most likely to sustain damage.
Human feet are strong and resilient. They are designed to stand up to decades of hard work, high impact, and vigorous physical activity. While heel pain is not as common in young people, after a lifetime of on their feet, sore heels are a recurring complaint for older Americans. People who wear tight shoes, ill-fitting shoes, shoes with insufficient cushion, have worked on their feet for many years, or who regularly wore high heels are more likely to experience heel pain later in life. Ironically, both obesity and a lifetime of extreme physical activity can increase your likelihood of heel pain.
Plantar Fasciitis
While many people refer to the plantar fascia as a ligament or tendon, it is anatomically labeled as an aponeurosis. For simplicity, we will refer to it as a ligament. The tendons and ligaments hold the bones together in ways that maintain the foot’s arch, and when it comes to heel pain, one ligament stands out: the plantar fascia. This is the longest ligament of the foot and runs from heel to toe. The ligament runs along the sole to form the arch of your foot. When you massage the bottom on your foot, you are massaging the plantar fascia.
This large, hard-working ligament stretches under tension all day, every day, in ways that provides the balance and the strength needed for walking. However, as this thick band of tissue becomes inflamed, you will begin to feel stabs of pain. Although this is a long, think ligament, the stabs will feel sharp, and sometimes localized. This pain may be most acute in the morning and decrease throughout the day as you “walk it out,” or it may return if you stand for long periods or after sitting. Resting with the foot limp can relieve this pain but standing will always inflame it again.
The effects of plantar fasciitis can range from mild to disabling. Simple home remedies like ice packs and rolling massages may relieve symptoms in mild cases, but while these may reduce short-term discomfort, these activities rarely eliminate the condition.
In most cases of plantar fasciitis, a doctor will need to intervene to reduce the inflammation, help the ligament heal, and manage the pain. During the doctor visit, your physician will perform a physical exam and talk to you about your symptoms. The doctor may take an X-ray to eliminate the possibility of other causes or conditions. Some patients may receive a steroid shot to reduce inflammation and discomfort, while stimulating healing. Other measures may include taping the foot or prescribing a night splint to keep the ligament stretched while it heals. Orthotics, and/or specific types of shoes may be recommended. Physical therapy may be recommended for some patients to strengthen the foot and to reduce the likelihood of future recurrences. The need for surgery is rare, however, each patient and situation is different, and treatments may vary.
Heel Pain and Heel Spurs
Heel pain affects your balance, your ability to walk, your posture, and your daily movements. Heel discomfort can be caused by a variety of factors, so avoid self-diagnosis and talk to your physician about your condition and your symptoms before embarking on any course of treatment.
Heel Spurs
When you get calcium deposits on the underside of your heel bone, you can develop a bony protrusion called a heel spur. While the spur itself is often painless, the presence of a heel spur is often associated with significant heel pain. Heel spurs are almost always associated with plantar fasciitis. X-rays are usually needed to confirm the size of the spur. Once the heel spur is assessed, your physician may prescribe some combination of physical therapy, custom orthotics, anti-inflammatory medication, and/or steroid injections. In extreme cases, surgery may be recommended. However, each patient and situation are different, and treatments may vary.
Other Common Causes of Heel Pain
There are many causes of discomfort in the heel, and the list below does not list all possible causes. Treatment and diagnosis your conditions may vary significantly based on the severity of the condition, the accompanying pain, as well as the age and health of the patient.
Achilles Tendonitis:
When the Achilles tendon is overuse or strained, it may become painful or inflamed. This is a common condition among people who suddenly increase the intensity of their workouts, and among older people engaging in physically demanding sports or activities. If you are experiencing significant or prolonged pain in your Achilles tendon, see a physician immediately.
Bursitis:
Bursae are fluid-filled sacs that form around joints, and next to tendons. They enable smooth motion of skin against bone and tendons. Therefore, because they form where tendons, skin, and muscle tissues meet bone, this is a common foot condition. Bursitis most frequently affects the heel and toes. Treatment can be as simple as a pain reliever and pads, or as extensive as surgery. See your physician to determine the best course of treatment for your condition.
Fractures or breaks:
A broken or fractured bone is considered a medical emergency and requires immediate care. If you’re not sure if the bone is fractured or broken, look for swelling, pain when the injured area is touched, inability to bear weight on the foot, inability to move the foot, or a visible deformity. Fractures and sprains are often confused. If you’re not sure of the severity of your injury, play it safe and see a physician immediately.
Sprains and strains:
Sprains and strains are injuries, small tears, or other type of damage to the ligaments, often caused by a sudden unusual or severe movement. Strains and sprains are common, and usually considered minor. However, significant swelling, deep bruising, or persistent pain are symptoms of severe sprains or fractures and require medical attention.
When to Call Your Doctor Immediately
While many forms of foot or heel pain are results of relatively minor conditions, you should call your doctor immediately if you experience the following:
- Severe pain
- Sudden pain
- Unusual redness in your heel
- Swelling in your heel
- Inability to walk because of the pain in your heel
Heel Pain Treatment
Some pain can improve over time with careful use, rest, and home applied treatments. There certainly are wraps, braces, pads, and other devices that you can purchase to help ease the pain, but many conditions are best suited for healing through the knowledgeable hands and techniques of a doctor, specifically an experienced Podiatrist and Orthopedic Surgeon.
Some Foot Treatment options include:
- Oral Pharmaceuticals – Anti-inflammatory drugs can reduce swelling and pain.
- Local Pharmaceuticals – Corticosteroid injections may be most effective where other drugs have underperformed.
- Physical Therapy – through recommended stretches and exercises improve muscle strength and flexibility for greater stability.
- Custom Orthotics – corrective and supportive orthopedic footwear and insoles can help correct foot faults and add cushion for healing purposes or for perpetual support.
- Surgery – for certain conditions, the only true path to healing and foot pain relief is surgery, such as plantar fasciitis and bone spurs.
If you’re battling heel pain, give Harford Lower Extremity Specialists a call at 410-836-0131 or click the Schedule An Appointment button below.