Heel pain is an extremely common complaint, and there are several common causes. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be
directed at the cause. If you have Heel Pain
, some causes include Plantar Fasciitis, Heel Spur,Tarsal Tunnel
Syndrome, Stress Fractures, baxter's nerve compression.
The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more
prone to developing plantar fasciitis. 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.
The symptoms of plantar fasciitis include pain along the inside edge of the heel near the arch of the foot. The pain is worse when weight is placed on the foot especially after a long period of rest
or inactivity. This is usually most pronounced in the morning when the foot is first placed on the floor. This symptom called first-step pain is typical of plantar fasciitis. Prolonged standing can
also increase the painful symptoms. It may feel better after activity but most patients report increased pain by the end of the day. Pressing on this part of the heel causes tenderness. Pulling the
toes back toward the face can be very painful.
The diagnosis of plantar fasciitis is generally made during the history and physical examination. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished
from these conditions. Pain can be referred to the heel and foot from other areas of the body such as the low back, hip, knee, and/or ankle. Special tests to challenge these areas are performed to
help confirm the problem is truly coming from the plantar fascia. An X-ray may be ordered to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to
cause problems. Other helpful imaging studies include bone scans, MRI, and ultrasound. Ultrasonographic exam may be favored as it is quick, less expensive, and does not expose you to radiation.
Laboratory investigation may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter's syndrome, or ankylosing spondylitis. These are
diseases that affect the entire body but may show up at first as pain in the heel.
Non Surgical Treatment
Rest until there is no more pain. This is the most important element of treatment as continuing to walk or run on the injured foot will not allow the injury to heal. Wear soft trainers with lots of
cushioning or pad the heel of shoes with shock absorbing insoles or heel pads. These should be worn in both shoes, even if only one heel is bruised. Wearing a raise in only one shoe causes a leg
length difference which can cause other problems. Replace running shoes if they are old. A running shoe is designed to last for around 400 miles of running. After this the mid soles are weakened
If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles
and joints or a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely
affecting their career. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your
plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as open surgery, where the section of the plantar fascia is released by making a
cut into your heel or endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia.
Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A
disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open
surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery,
plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and
disadvantages of both techniques with your surgical team.
You can try to avoid the things that cause heel pain to start avoid becoming overweight, where your job allows, minimise the shock to your feet from constant pounding on hard surfaces, reduce the
shocks on your heel by choosing footwear with some padding or shock-absorbing material in the heel, if you have high-arched feet or flat feet a moulded insole in your shoe may reduce the stresses on
your feet, if you have an injury to your ankle or foot, make sure you exercise afterwards to get back as much movement as possible to reduce the stresses on your foot and your heel in particular, If
you start to get heel pain, doing the above things may enable the natural healing process to get underway and the pain to improve.