Heel Problem

The most common causes of heel pain are plantar fasciitis (bottom of the heel) and Achilles tendinitis (back of the heel). Heel pain may occur due to a single injury, such as a twist or fall, or from repetitive stress and pounding of the heel. Flat footwear may also stretch the plantar fascia until the area becomes swollen or inflamed, causing pain and discomfort.

Heel Problems

Both heel pain and heel spurs are frequently associated with an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation is called Plantar Faciitis. It is common among middle age adults especially those who are active and stand for long periods of time.

The condition occurs when the plantar fascia is strained over time beyond its normal extension limits, causing the soft tissue fibers of the fascia to tear or stretch. This leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.
The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an active lifestyle.

Resting or sleep provides only temporary relief. When you resume walking, particularly the first step out of bed in the morning, you may experience pain and stiffness. The pain slowly resides as the fascia stretches, or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive activity.

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How to Prevent Heel Problem?

A variety of steps can be taken to avoid heel pain and associate Plantar Fasciitis

Wear shoes that fit well in front, back and sides and have shock absorbent soles, rigid shanks and supportive heel counters.
Wear the proper shoes for each activity.
Do not wear shoes with excessive wear on heels or soles.
Prepare properly before exercising. Warm up and do stretching exercises before and after running.
Pace yourself when you participate in athletic activities.
Don't underestimate your body's need for rest and good nutrition.
If overweight, try to diet and exercise.

Treatment

If pain and other symptoms of inflammation-redness, swelling, heat-persist, you should limit normal daily activities and contact a doctor of podiatric medicine.
The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone.

Early treatment might involve oral or cortisone type anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy, such as massage and laser therapy, may be used in conjunction with such treatments.

A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting of the ligaments and tendons attaching to the heel bone. Custom made orthotic devices effectively treats the majority of heel and arch pain without the need for surgery.

In relatively few cases of heel pain are more advanced treatments or surgery required. If surgery is necessary, it usually involves the release of the plantar fascia, and a possible heel spur excision. Chronic heel pain lasting greater than three weeks should be addressed by a podiatric physician.

Haglunds Deformity

Haglund's Deformity (also known as pump bump or retrocalcaneal bursitis) is a painful enlargement on the back of the heel bone that becomes irritated by shoes. It normally appears as a red, painful, and swollen area in the back of the heel bone. Women tend to develop the condition more than men because of irritation from rigid heel counters in shoes that rub up and down on the back of the heel bone. Irritation can be resolved with anti-inflamatories and icing.

If the problem persists a surgical correction to reduce the size of the posterior lateral aspect of the heel bone is done. A complete description of the surgery will be discussed by your Podiatric physician. X-rays and a biomechanical exam will be necessary to determine the extent of surgery and the down time needed for recovery.

Heel Fissures

Heel fissures is the term for cracking of the skin of the heels. This can be a painful condition that can cause bleeding. Dryness and Open-backed sandals or shoes that allow more slippage around the heel while walking are often culprits that cause heel fissures. Skin conditions, such as eczema and psoriasis, can also lead to heel fissures. The skin thickens as a result of the friction. Wearing proper shoes and the use of deep skin moisturizers and lotions can reduce the dryness associated with the condition and allow the foot to heal. A few visits to your Podiatrst for a reduction of the callused skin along with an Rx for skin emolients can completely resolve this issue.

As a general rule, Heel Problems and its procedures are performed on an out-patient basis in an Alberta Health Services (AHS) approved Surgical Center or in a Hospital. Surgical procedural costs are covered by AHS or the patient may opt for private surgery to avoid a waiting time. A visit to Feldman & Leavitt Foot And Ankle Specialists will CLEARLY define all available patient options.

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Frequently Asked Questions

What exactly is the Heel Problem?

The heel problem occurs when each mile you walk places a great deal of strain on each foot or both feet. Your feet can withstand a heavy load, but too much stress stresses them out. You may develop heel pain or problems if you pound your feet on hard surfaces while playing sports or wear shoes that irritate sensitive tissues. The most common heel problem is a sore heel that will usually heal on its own without surgery if you give it enough rest. Many people, however, ignore the early signs of heel pain and continue to engage in the activities that caused it. Walking on a sore heel will only make it worse and may develop into a chronic condition, leading to additional problems.

How are heel problems diagnosed?

There are numerous causes of heel pain. If your heel hurts, see your primary care physician or a foot and ankle orthopedic surgeon as soon as possible to determine the cause and receive treatment. Tell him or her where the pain is and how long it has been there. Your doctor will examine your heel, looking for signs of tenderness and swelling and feeling it. You may be asked to walk, stand on one foot, or perform other physical tests to assist your doctor in determining the source of your sore heel. Heel pain conditions are divided into two categories: pain beneath the heel and pain behind the heel.

What are the things you notice when you have a heel problem?

Pain Beneath the Heel
If you have pain under your heel, you may have one or more of the following conditions that cause inflammation of the tissues on the bottom of your foot: Stone bruise: When you step on a hard object, such as a rock or stone, the fat pad on the underside of your heel can be bruised. It could be discolored or not. With rest, the pain gradually fades. Plantar fasciitis (subcalcaneal pain): Excessive running or jumping can cause inflammation of the tissue band (fascia) that connects the heel bone to the base of the toes. The pain is centered under your heel and may be mild at first, but it worsens when you take your first steps after sleeping. You may need to perform special exercises, take anti-swelling medication, and wear a heel pad in your shoe.Heel spur: If plantar fasciitis is left untreated for an extended period of time, a heel spur (calcium deposit) may form where the fascia tissue band connects to your heel bone. To see the bony protrusion, your doctor may order an X-ray. Treatment is usually the same as for plantar fasciitis: rest until the pain goes away, do stretching exercises, and wear heel pad shoe inserts. A heel spur may not cause pain and should not be surgically removed unless symptoms become chronic.

Pain Behind the Heel
You may have inflamed the area where the Achilles tendon inserts into the heel bone if you have pain behind your heel (retrocalcaneal bursitis). This is frequently caused by excessive running or wearing shoes that rub or cut into the back of the heel. Pain behind the heel can develop gradually over time, causing the skin to thicken, turn red, and swell. A bump on the back of your heel may form that feels tender and warm to the touch. The pain may worsen when you first begin an activity after resting. It frequently hurts too much to wear regular shoes. An X-ray may be required to determine whether you have a bone spur. X-rays are occasionally ordered to further evaluate the condition. Furthermore, the surgeon may refer the patient to a neurologist for a thorough neurologic examination.

How do you cope with or treat heel pain?

Resting from the activities that caused the problem, stretching exercises, pain medication, cushioned heel cups, and wearing open-back shoes are all part of the treatment. Your doctor may recommend that you use a 3/8" or 1/2" heel insert. Lean against a wall with your foot flat on the floor and heel elevated with the insert to stretch your Achilles tendon. Stretching your Achilles on a stepstool can also be beneficial. For pain and swelling, take nonsteroidal anti-inflammatory medications. To reduce inflammation, apply ice to the back of the heel.

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For more information on Heel Problem, book a surgical consultation with one of our board certified podiatric surgeons

For more information on Heel Problem, book a surgical consultation with one of our board certified podiatric surgeons

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