Pamela Lovas

A Foot Conditions Database

Do You Understand Heel Pains?

Overview

Heel Pain

Plantar heel pain is a commonly encountered orthopedic problem that can cause significant discomfort and a limp because of the difficulty in bearing weight. The etiologies of this condition are multiple; therefore, a careful clinical evaluation is necessary for its appropriate management. Nonsurgical or conservative care is successful in most cases.

Causes

Near the inflamed plantar fascia attachment, but not in it, some extra bone may form, producing a small "spur". In fact, it is a shelf of bone, not a sharp spur. These "heel spurs" are commoner in people with plantar fascitis, but they can be found in people with no heel pain. The heel spur is caused by the same process as the heel pain, but the spur is not itself the cause of the pain.

Symptoms

Initially, this pain may only be present when first standing up after sleeping or sitting. As you walk around, the muscle and tendon loosen and the pain goes away. As this problem progresses, the pain can be present with all standing and walking. You may notice a knot or bump on the back of the heel. Swelling may develop. In some cases, pressure from the back of the shoe causes pain.

Diagnosis

Your doctor will perform a physical exam and ask questions about your medical history and symptoms, such as have you had this type of heel pain before? When did your pain begin? Do you have pain upon your first steps in the morning or after your first steps after rest? Is the pain dull and aching or sharp and stabbing? Is it worse after exercise? Is it worse when standing? Did you fall or twist your ankle recently? Are you a runner? If so, how far and how often do you run? Do you walk or stand for long periods of time? What kind of shoes do you wear? Do you have any other symptoms? Your doctor may order a foot x-ray. You may need to see a physical therapist to learn exercises to stretch and strengthen your foot. Your doctor may recommend a night splint to help stretch your foot. Surgery may be recommended in some cases.

Non Surgical Treatment

If you have experienced painful heels try wearing your shoes around your house in the evening. Don't wear slippers or socks or go barefoot. You may also try gentle calf stretches for 20 to 30 seconds on each leg. This is best done barefoot, leaning forward towards a wall with one foot forward and one foot back. If the pain persists longer than one month, you should visit a podiatrist for evaluation and treatment. Your feet should not hurt, and professional podiatric care may be required to help relieve your discomfort. If you have not exercised in a long time, consult your podiatric physician before starting a new exercise program. Begin an exercise program slowly. Don't go too far or too fast. Purchase and maintain good shoes and replace them regularly. Stretch each foot and achilles tendon before and after exercise. Avoid uneven walking surfaces or stepping on rocks as much as possible. Avoid going barefoot on hard surfaces. Vary the incline on a treadmill during exercise. Nobody walks uphill all the time. If it hurts, stop. Don't try to "work through the pain." Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.

Surgical Treatment

When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.

pain in back of heel

Prevention

Feet Pain

You can reduce the risk of heel pain in many ways, including. Wear shoes that fit you properly with a firm fastening, such as laces. Choose shoes with shock-absorbent soles and supportive heels. Repair or throw out any shoes that have worn heels. Always warm up and cool down when exercising or playing sport, include plenty of slow, sustained stretches. If necessary, your podiatrist will show you how to tape or strap your feet to help support the muscles and ligaments. Shoe inserts (orthoses) professionally fitted by your podiatrist can help support your feet in the long term.
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