Heel Pain, Heel Spurs
What is heel pain?
Most heel pain occurs on the bottom of the heel. Heel pain can seem to occur for no apparent reason and can become worse when you attempt to put weight on the foot. Patients commonly notice the pain when they first get out bed in the morning or when getting up to stand after sitting for a long period of time. Most of the time the pain is caused by overuse, such as extra standing or walking, a change in job with increased time on your feet, increased fitness activity, increased walking while on vacation, or too much time spent barefoot or in poor shoes.
Pain in the bottom of the heel can feel sharp and searing, or can feel like a tearing sensation. After you have been on your feet, the pain can progress to a throbbing feeling, and the area may feel sore from the heel up the back of the leg. Sometimes the pain can even be present in the arch of the foot.
In order to understand what is causing your foot pain, it’s important to gain a basic understanding of the anatomy of the foot and how it functions. The plantar fascia, a thick ligament, is attached to the bottom of the heel, fanning out through the ball of the foot to the toes. The plantar fascia acts as a shock absorber for your foot and does not stretch very much as it is made of dense, fibrous connective tissue. When you take a step, your foot flattens and lengthens, pulling on the plantar fascia. As you bring your heel off the ground, the tension releases and allows the foot to continue functioning properly.
Anything that causes excessive flattening of the foot will stretch the plantar fascia beyond what is normal. When this occurs, small tears can develop where the ligament attaches into the heel bone, causing pain and a small amount of bleeding. The tension in the heel bone can also cause a bone spur to develop on the bottom of the heel; however, many people experience little to no symptoms or pain from heel spurs.
What causes the foot to flatten excessively?
The primary factor that causes the foot to flatten too much is the structure of the subtalar joint, a joint complex below the ankle. The joint complex moves as you step to flatten or heighten the arch of your foot. If your foot pronates, or flattens, excessively during walking or standing, your plantar fascia becomes strained. Over time, this can weaken the ligament near its attachment to the heel bone and cause pain. When you are resting or off of your feet, the plantar fascia attempts to mend itself, but it can re-tear as you resume walking and cause pain again. This is why it is common to have pain in the morning or after rest. Generally, if you continue moving, the pain diminishes.
Tight calf muscles can also contribute to the flattening of your foot’s arch. The calf muscles are attached to the back of the heel with the achilles tendon. When your calf muscle is tight, it limits the movement of your ankle joint. This causes the subtalar joint to pronate excessively, which can contribute to several different problems in the foot.
Tightness of the calf muscles can be caused by exercise, such as walking or jogging, and inactivity or prolonged rest. In addition, wearing high heels or western-style cowboy boots can cause you to develop tight calf muscles over time.
Your podiatrist can diagnose heel pain and bone spurs during a physical exam. A weight-bearing x-ray is often used to determine if a spur is present in the heel bone and to rule out any other causes of heel pain, such as a heel bone stress fracture or the presence of bone tumors.
Generally, treatment of heel pain occurs in stages to allow for proper healing and the prevention of further pain.
1. Aggressive stretching
At the earliest sign of heel pain, your podiatrist will most often recommend aggressive calf muscle stretching to reduce the tightness of the muscle and tension in the plantar fascia. You may need to take an oral anti-inflammatory medication to help the healing begin and possibly wear over-the-counter arch supports or heel cushions.
2. Arch support
The next phase of treatment may consist of a night splint, cortisone injections, and taping of the foot. All of these measures will help support the arch and prevent more pain. You will still need to continue to stretch your calf muscles regularly.
3. Foot orthotics
If after the previous stages, you continue to feel pain in your heel, you may need to consider functional foot orthotics. A functional orthotic fits in your shoe like an arch support; however, unlike an over-the-counter arch support, a custom orthotic is made specifically for your foot and improves the excessive pronation of the subtalar joint and overall foot function. Your doctor can perform the fitting for your custom device.
If in the event that orthotics fail to treat your foot pain, surgery may be recommended. There are exceptions to the course of treatment described above and it is up to your podiatrist and you to determine the best course of treatment for your heel pain. If surgical treatment is recommended and you elect to have the procedure, you will likely have to continue using the already prescribed orthotic device to support your foot. Surgery can eliminate the pain, but does not correct the cause of heel pain. Without the continued use of orthotics, the process that caused the pain can continue.