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Don’t Let Heel Pain Slow You Down!

  • Category: General
  • Posted On:
  • Written By: Eric K. Bartel, MD
Don’t Let Heel Pain Slow You Down!

Knock the snow off your shoes! In a few days, it will be officially spring, no matter how things appear outside. Now’s the time to get out the walking shoes, tune up the bicycle and bring out the golf clubs. Just be sure that in addition to a new swing, you don’t develop something else new — HEEL PAIN.

Heel pain is one of the most common musculoskeletal problems that lead people to seek medical attention. It is estimated that up to 80% of all people experience heel pain at some time in their lives. Fortunately for the majority, the pain resolves spontaneously or with a little rest and they never need to seek medical care.

For the rest of us, this can become a chronic and debilitating problem leading to decreased activity, weight gain and a poor round of golf (amongst other things). If you can’t exercise due to the pain, you put on weight. The more weight on your feet, the more they hurt. But if you can’t exercise, how do you lose weight? To make matters worse, the longer you have the pain, the more difficult it is to cure it. Prevention and early treatment are the keys!

But what is heel pain? It is actually any one of a number of injuries to the foot. These are considered “overuse” injuries since they are caused by a change in activity or repetitive stress to your foot rather than one specific accident.

The new or increased stress to your foot overloads the normal repairative processes of your body and leads to injury. Sometimes old or incorrect shoes can lead to new pain. The most common types of heel pain include plantar facsiitis (also called heel spurs), Achilles Tendonitis and stress fractures. They all have similar symptoms and may be difficult to distinguish without a thorough medical exam.

Plantar fasciitis is an inflammation of a ligament in the sole of your foot where it attaches to the heel bone. It is commonly associated with a bone spur seen on x-ray studies. The pain is on the bottom or inside of the heel. It is worse when getting out of bed or after sitting for period of time. You may note a dull ache after long periods of standing or walking. High impact activities such as aerobics and jogging are the most painful, but occasionally simple acts such as walking may be excruciating. Some swelling near the heel may be noted at the end of the day. Irritated nerves to the heel may give a burning sensation to the pain.

People with high arches, diabetes or poor flexibility are at the greatest risk of developing plantar fasciitis. Most cases that require treatment will resolve with simple measures. Medications to reduce the swelling and alleviate pain, regular icing to the foot and heel pads or cups are quite helpful. Stretching the ligament and foot are essential to taking tension off the ligament and allowing it to heal. Occasionally, steroid injections and walking casts are necessary. Surgery is only needed for particularly severe or chronic cases.

Achilles Tendonitis may mimic plantar Fasciitis in the quality and severity of pain. However, it is usually located in the posterior heel where the Achilles tendon attaches to the heel bone. It may be associated with a discrete swelling or bursitis, which is irritated by the backs of shoes.

Pushing off your toes while walking, jumping or reaching for the top shelf can set off the pain. Anti-inflammatory medications to reduce pain and swelling, along with ice, rest and a stretching program are usually curative. Walking casts will help in resistant cases. Steriod injections should be used cautiously to avoid weakening the tendon.

Stress fractures of the heel bone also give pain on the bottom and sides of the heel. They are an accumulation of “microfractures” in the heel bone. Swelling is much more prominent and bruising may also be seen. The amount of pain is directly related to the amount of activity that day and does not decrease with stretching. Normal x-ray studies may not show a stress fracture for several weeks and special radiographic tests may be needed to make the diagnosis. Restriction of impact activities, cushioned heel pads and medications are all that is needed to allow the bone to heal.

These are only three causes of heel pain. However, all three types are easily preventable. First, simple stretching exercises before activities will keep tissues pliable and resistant to overload. Second, keep your feet in good fitting, supportive, cushioned shoes to reduce the impact to your feet. Finally, avoid sudden increases or changes in activity that might injure your feet. Gradual progression in activities is best. If you do develop pain, avoid painful activities, use ice and over-the-counter anti-inflammatory medications. Seek medical attention if there is no improvement.