Heel Pain

The heel is the largest bone in the foot. Heel pain is the most common foot problem and affects 2 million Americans every year. It can occur in the front, back, or bottom of the heel. Types of heel pain include:
  • Achilles tendinitis
  • Bursitis of the heel
  • Excess pronation
  • Haglund's deformity
  • Heel spur syndrome
  • Plantar fasciitis
Achilles Tendinitis
Achilles tendinitis is an inflammation of the tendon that connects the calf muscles to the heel bone. It is caused by small tears in the tendon from overuse or injury. This condition is most common in people who engage in high-impact exercise, particularly jogging, racquetball, and tennis.
Of the people who engage in these activities, those at the highest risk for this disorder are the ones with a shortened Achilles tendon. Such people tend to roll their feet too far inward when walking, and may bounce when they walk. A shortened tendon can be due to an inborn structural abnormality, or it can develop from regularly wearing high heels.
An inflamed or torn Achilles tendon causes intense pain and affects mobility.
Some treatment approaches include:
  • Treatments to relieve pain and reduce inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil) may help ease pain and reduce inflammation. It is also helpful to apply ice for 20 - 30 minutes, four or five times a day. 
  • Gentle stretching. Gentle calf muscle stretches may also help reduce pain and spasms. If the calf is swollen, elevate the leg. Exercise is safe when the heel is no longer swollen or tender, even if the pain is still present. If pain increases with exercise, stop immediately.
  • Surgery vs. Nonsurgical Treatment. Chronic inflammation may lead to rupture of the Achilles tendon. If pain continues, the ruptured tendon will require a cast and perhaps surgery, called a tendon transfer. Although some experts believe a cast without surgery is sufficient treatment for such rupture, there is a chance the tendon may rupture again in the future, even after it heals. Some experts suggest surgery for active people and nonsurgical treatment for older people. Surgery requires a long incision with a postoperative period of immobilization that can average 6 weeks. Complications can include a significant surgical scar, infection, and muscle atrophy, although surgery reduces pain and preserves foot function in the long term.
Bursitis Of The Heel
Bursitis of the heel is an inflammation of the bursa, a small sack of fluid beneath the heel bone. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil), and steroid injections will help relieve pain from bursitis. Applying ice and massaging the heel is also beneficial. A heel cup or soft padding in the heel of the shoe reduces direct impact when walking.

Excessive Pronation
Pronation is the normal motion that allows the foot to adapt to uneven walking surfaces and to absorb shock. Excessive pronation occurs when the foot has a tendency to turn inward and stretch and pull the fascia. It can cause not only heel pain, but also hip, knee, and lower back problems.

Haglund's Deformity
Haglund's deformity, known medically as posterior calcaneal exostosis, is a bony growth surrounded by tender tissue on the back of the heel bone. It develops when the back of the shoe repeatedly rubs against the back of the heel, aggravating the tissue and the underlying bone. It is commonly called a pump bump because it frequently occurs with high heels. (It can also develop in runners, however.)
Treatment for Haglund's Deformity may include:
  • Applying ice followed by moist heat will help ease discomfort from a pump bump.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil), will also reduce pain.
  • Your doctor may recommend an orthotic device to control heel motion. Corticosteroid injections are not recommended because they can weaken the Achilles tendon.
  • In severe cases, surgery may be necessary to remove or reduce the bony growth. Studies show, however, that recovery from surgery is very long, and success rates vary. Experts advise patients to try all conservative measures before choosing surgery.
Plantar Fasciitis & Heel Spur Syndrome
Plantar fasciitis is a common foot problem that accounts for 1 million office visits per year. Plantar fasciitis occurs from small tears and inflammation in the wide band of tendons and ligaments that stretch from the heel to the ball of the foot. This band, much like the tensed string in a bow, forms the arch of the foot and helps serve as a shock-absorbent for the body.
The term plantar means the sole of the foot, and fascia refers to any fibrous connective tissue in the body. Most people with plantar fasciitis experience pain in the heel with their first steps in the morning. The pain also often spreads to the arch of the foot. The condition can be temporary, or it may become chronic if ignored. Resting can provide relief, but only temporarily.
Heel spurs are calcium deposits that can develop under the heel bone as a result of the inflammation that occurs with plantar fasciitis. Heel spurs and plantar fasciitis are sometimes blamed interchangeably for pain, but plantar fasciitis can occur without heel spurs and commonly develop without causing any symptoms at all.

Causes of Plantar Fasciitis:
  • The primary cause of plantar fasciitis is often unknown; however, it is usually associated with overuse during high-impact exercise and sports.
  • Plantar fasciitis accounts for up to 9% of all running injuries. Because the condition often occurs in only one foot; however, factors other than overuse are likely to be responsible in many cases. Other causes of this injury include poorly-fitting shoes, lack of calf flexibility, or an uneven stride that causes an abnormal and stressful impact on the foot.
The three major treatment goals for plantar fasciitis are:
  • Reducing inflammation and pain
  • Reducing pressure on the heel
  • Restoring strength and flexibility