Heel pain is one of the most common conditions treated by podiatrists. It is often a message from the body that something is in need of medical attention. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we have suffered. The greatest incidence of heel pain is seen in middle-aged men and women. It is also seen in those who take part in regular sporting activities and those significantly overweight and on their feet a lot. Heel pain can also occur in children, usually between 8 and 13, as they become increasingly active in sporting activities.
One of the most common heel pain causes is a condition called plantar fasciitis. The tendons, ligaments, muscles, and joints in the feet all work together to allow you to move your feet to walk or run. When the plantar fascia, or the arch of the foot, is overused or injured, pain is felt in the heel. The most common heel pain causes include plantar fasciitis, Achilles tendonitis, Bursitis, Fibromyalgia, Bone fracture, Heel spurs, Arthritis, Tarsal tunnel syndrome, Sever?s Disease.
Usually worse with the first few steps in the morning or at the initial point of activity. The latter usually gets better with continued activity (squeaky hinge analogy). Walking, running, sprinting, hill running and jumping will increase the pain. Often, the natural response is to walk on the outside of the foot - in supination - to lessen the stress on the plantar fascia - resulting in new problems.
After you have described your foot symptoms, your doctor will want to know more details about your pain, your medical history and lifestyle, including. Whether your pain is worse at specific times of the day or after specific activities. Any recent injury to the area. Your medical and orthopedic history, especially any history of diabetes, arthritis or injury to your foot or leg. Your age and occupation. Your recreational activities, including sports and exercise programs. The type of shoes you usually wear, how well they fit, and how frequently you buy a new pair. Your doctor will examine you, including. An evaluation of your gait. While you are barefoot, your doctor will ask you to stand still and to walk in order to evaluate how your foot moves as you walk. An examination of your feet. Your doctor may compare your feet for any differences between them. Then your doctor may examine your painful foot for signs of tenderness, swelling, discoloration, muscle weakness and decreased range of motion. A neurological examination. The nerves and muscles may be evaluated by checking strength, sensation and reflexes. In addition to examining you, your health care professional may want to examine your shoes. Signs of excessive wear in certain parts of a shoe can provide valuable clues to problems in the way you walk and poor bone alignment. Depending on the results of your physical examination, you may need foot X-rays or other diagnostic tests.
Non Surgical Treatment
Shoes, orthoses, splinting and/or immobilization form the cornerstone for successful functional management of plantar fasciitis.When you take the overuse nature of plantar fasciitis into account and attempt to re-establish the windlass mechanism of the foot, there is an enhanced potential for success. Unfortunately, too little attention has been directed to appropriately managing the shoes worn during treatment for plantar fasciitis. Emphasising motion control and stability type athletic shoes (that provide a firm heel cup, instep rigidity, longitudinal integrity and a well-integrated shoe upper) can help decrease excess eccentric tissue strain. The shoe also serves as a vital and functional link between an orthotic and the foot. Orthoses have long been considered to be a reliable method for treating plantar fasciitis. Considerable debate has been waged over the benefits of over-the-counter (OTC), prefabricated and prescription foot and/or ankle orthoses. Heel cushions, heel cups and cushioning pads appear to provide immediate pain relief for many people who have plantar fasciitis.This relief is frequently short-lived and requires other treatment modalities for success.Neutral position taping and strapping of the foot provides temporary symptomatic relief of pain caused by plantar fasciitis. Although the functional benefits are temporary and likely do not last longer than 10 minutes with exercise, the soft tissue compression and symptomatic relief afforded by the strapping can last for nearly a week.
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.
clearly adjustable heel lifts
Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight, and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet, can be beneficial for your feet. Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels.