Ask The Doctor

 

What is Heel Pain?

Most people will develop some form of heel pain during their lifetime. Heel pain can be relatively easy to treat, but in some cases, can linger for years resulting in surgery or many modes of treatment.  There are an estimated 2 million doctor visits a year dealing with heel pain, not including the many who chose a home remedy or ignore their symptoms.

As you can see, heel pain is a fairly common complaint.  There are also several common causes of heel pain that need to be identified to help diagnose and treat it correctly.  Some common causes include:

• Plantar Fasciitis

• Heel Spurs

• Stress Fractures

• Achilles tendonitis

We will touch on each of these below.

Plantar Fasciitis

Plantar fasciitis is the most common condition causing heel pain. Plantar fasciitis is a form of irritation and inflammation of the thick band of tissue that forms the arch of the foot. Plantar fasciitis often is worst during the morning upon waking. The most common cause of plantar fasciitis is poor foot structure which is exasperated by lifestyle and poor footwear choices. People with flat feet or high arched feet are increased risk at developing plantar fasciitis.  Non-supportive footwear on hard, flat surfaces also contribute.  Working long hours while standing and being overweight will aggravate poor foot structure.

Heel Spur

A spur is commonly associated with plantar fasciitis. This problem is most commonly seen in patients who have long standing heel pain due to plantar fasciitis.

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome causes a large nerve in the back of the foot to become entrapped, or pinched. Similar to carpal tunnel syndrome in the hand, tarsal tunnel syndrome can cause heel pain.

Stress Fractures

Stress fractures of the calcaneus are an uncommon cause of heel pain. Stress fractures should be considered especially in athletes such as long distance runners who have heel pain.

Posterior Heel Pain

Posterior heel pain causes symptoms behind the foot, rather than underneath. Posterior heel pain causes include Achilles tendonitis and retrocalcaneal bursitis. Learn about causes of posterior heel pain and what treatments are available.

What is achilles tendonitis?

The Achilles tendon is a long tendon running along the back of your lower leg from the back of the knee to the heel. The tendon enables us to walk helping to raise the heel off the ground. It is the strongest and largest tendon in the body, and therefore when injured, can substantially affect your life.

Athletes participating in sports with sudden starts and stops are usually the highest risk for developing Achilles Tendonitis.  Proper conditioning is a must to help prevent this injury from developing  along with the proper equipment, footwear, and a good surface.

Achilles Tendonitis mostly stems from overuse or the tendon not being conditioned to handle strain. For example, people who have not exercised for a long time and then start a new routine will have an increased risk of strain put on the Achilles Tendon. During a prolong period of minimal to no activity, tendons can become stiff and inflexible. Stretching and easing into new activities will help prevent Achilles Tendonitis.

Wearing high heels also increases the risk of Achilles Tendonitis. This will mainly effect women, as wearing the high heel over time allows the tendon to adapt and shorten in length. Upon switching back to regular flat soled shoes, more stress is placed on the Achilles Tendon and can create inflammation. 

Symptoms of Achilles Tendonitis

Symptoms usually develop over time gradually or are brought on after strenuous activity. Pain can be mild but worsen if the tendon continues to receive stress. Pain is always a sign to cease activity and treat the condition because of the risk of rupture, which is extremely painful and takes much longer to recover from.

Symptoms include:

• Pain in the Achilles Tendon during or after exercise

• Swelling in the areas around the tendon

• Red irritation or inflammation of the skin around the Achilles Tendon

• Stiffness or difficulty stretching the Achilles Tendon, especially without pain

• Pain when walking, moreso going uphill

• Pain or stiffness upon waking in the morning

Achilles Tendonitis Treatment Options

Treatment ultimately depends on the severity of the injury. We always recommend seeking the advice of a trained medical professional before using any treatment options yourself. There are several things you can do to help heal your injury, but always seek help if the condition persists or worsens. Some treatment options include:

• RICE treatment (Rest, Ice, Compression, Elevation)

• Relax your lower leg on softer surfaces while laying down (pillow, blanket)

• Wear a heal pad or brace that will raise your heel

• Take anti-inflammatory meds that your body can tolerate

There are some orthopedic braces we recommend to treat Achilles tendonitis, including the Ortho Heal pneumatic air brace. The air bladder in this brace really massages the area, along with providing a raised heel and soft compression to the area. We have a review of the product here.  

In any event, if you injure your Achilles Tendon during any activity, it is probably best to immediately cease doing the activity until fully recovered or at least checked out buy a physician. A ruptured Achilles tendon is one of the most painful injuries to experience and also requires surgery in most cases. The rehab process can take up to a year. Obviously this is something nobody wants to experience in their lifetime, so remember to listen to your body and take good care of even minor injuries as they may develop into something more serious.

What is Calcaneal Apophysitis 

Calcaneal apophysitis, or Sever's disease, is an inflammation of the growth center of the heel bone, or calcareous in children. It frequently occurs in boys age 10-12 and girls age 9-12 who are active in sports during peak growth spurts. The condition is known as apohysitis, because this area of the heel bone in children is known as the apophysis. Symptoms of calcaneal apophysitis are pain on the bottom and around the edges of the heel bone that is aggravated by activity and relieved by rest.

 What causes Calcaneal Apophysitis?

• Calcaneal Apophysitis is caused by trauma or injury to the growth center of the heel bone in physically active children between the ages of 9 to 12.

• Activities such as running, jumping, going barefoot, participating in sports such as basketball, soccer, baseball, tennis, etc. will aggravate the condition.

• Biomechanical abnormalities of the foot such as flat feet can cause apophysitis.

• Tightness of the Achilles tendon can cause apophysitis.

• Improper footwear can cause the condition.

• Wearing cleated shoes can cause and aggravate the condition as well as running on hard surfaces.

How is Calcaneal Apophysities Treated?

• Avoid going barefoot and running on hard surfaces.

• Wear soft shoes such as athletic shoes.

• Oral anti-inflammatory medications (if they are ok with your physician) such as children's Tylenol, or children's Advil.

• Limit physical activity that may cause the heel pain.

• A stretching program that involves the lower leg may help treat and prevent calcaneal apophysitis.

• Cases that don't respond to the above are treated will heel cups or custom made supports.

We recommend a pneumatic type brace such as the Ortho Heal for remaining active with calcaneal apophysitis.  Once pain has healed, our over the counter orthotic inserts better align the foot to help prevent future injury.

Cases that don't respond to the above are commonly helped with our gel heel cups and compression sock.

How do doctors treat heel pain?

We asked our clinical physicians how they typically treat heel pain and this is the result of those interviews.

Interviewer: “So doctor how do you treat heel pain?”

Doctor: “We see a lot of heel pain in our office. It is probably the number one complaint we see daily. Most people come in with complaints of pain with the first step in the morning or pain in the heel as the day goes on. Most people say they have had their pain for several months and it seems to be getting worse. We find the longer people go without treatment the harder it is to get them over heel pain.  We will xray their foot to rule out a stress fracture, arthritis, bone tumor or congenital anomaly of the heel first. A lot of times we see heel spurs on the xray. Next, we will ultrasound their foot to measure the thickness of the fascia to determine if it is inflamed. After the imaging is done we will take a thorough history and physical of the patient followed with a physical exam to truly determine the cause of the heel pain. Once we have diagnosed plantar fasciitis we discuss the treatment protocol with the patient.”

“Our first line treatment is stretching exercises, NSAIDS if they can tolerate them and an Ortho Heel with night splint combination. We find stretching is key to helping the body recover. The NSAIDS help with the inflammation and pain to allow the patient to stretch better and reduce symptoms. If for some reason the patient cannot take NSAIDs we will ask them to purchase Ortho X pain cream to reduce the pain. We recommend they use it at least twice a day. The Ortho Heal is dispensed to the patient with instructions to wear it daily in a good supportive shoe like a tennis shoe. We also have them use the night splint for night time stretching and reducing the first pain in the morning. We ask to see the patient back in two weeks for a follow up.”

Interviewer: “Do most people get better after one treatment?”

Doctor: “A lot of people do get better with this treatment protocol. When patients have had long standing heel pain they have not tried to address it can take more aggressive treatment. The ones that do not we will usually have them continue the initial treatment and add steroid injections into the heel to help. Sometimes up to three injections over the course of several weeks. If this does not help we try physical therapy, walking boots, orthotics and ultimately surgery.”

Interviewer:  ”Do many people have to have surgery?”

Doctor:  ”Most people will recover from heel pain without surgery.”

Interviewer: “Do most people need orthotics for plantar fasciitis?”

Doctor: “We commonly recommend the pure stride inserts for patients after they get over the heel pain to help them not get a reoccurrence of plantar fasciitis. In more rare cases we have to prescribe them custom made orthotics but we try to not do this due to how much custom orthotics cost. Usually about 350 dollars.”

What will help my heel pain?

Plantar fasciitis and heel pain can be a very disabling condition suffered by many people. It is has been studied by doctors for a long time.  Most of the treatments focus on stretches exercises for the primary treatment patients’ can do at home. See our stretching pamphlet.  Our physician clinical advisers also recommend the Ortho Heal for the acute symptoms of heel pain during the day, while using the Ortho X pain cream for day and night relief. The plantar fascial night splint will help alleviate those painful first steps in the morning. For long term care they also recommend the Pure Stride inserts to keep the heel pain away.

If your budget is small the Ortho Sock with gel heel cups and pain cream can get you moving in the right direction with a good stretching program. Icing is helpful to reduce inflammation with heel pain as well. Heel pain can take several weeks and even months to fully get over with proper care.  Our advisors remind heel pain sufferers to hang in there and keep using the bracing, pain creams and stretches to keep you on your feet and at work.

Do heel spurs cause heel pain?

Heel spurs are commonly seen with plantar fasciitis and heel pain. Sometimes the heel spur can be on the bottom of the foot or the back of the heel.

 

The heel spur is a bony overgrowth of calcium caused by the excessive strain and pull on the Achilles tendon or plantar fascia. The spurs are kind of a way your body is trying to heal itself. The spurs are not typically surgically removed anymore. Many people and products out there claim to dissolve spurs, but this is just silly. The spur can only be removed by a surgeon. Heel spur syndrome, which is pain in the back of the heel or the bottom of the heel responds well to conservative options such as stretches and bracing. See our recommended products to help alleviate your symptoms today!

Will stretches help my heel pain?

Heel pain and plantar fasciitis are typically from the tightening of the tissue on the bottom of the foot. This condition can be caused from a fatigue in the foot from daily wear and tear, recent weight gain, changes in foot wear or starting a new exercise program. Stretching is an important part of a heel pain protocol. Our clinical physicians have recommended stretching to their patients’ on a consistent basis. They also will recommend the patient rest, elevate and ice the area daily. Heel pain bracing, such as the Ortho Heal deliver pain relief by offloading the plantar fascia and massaging the area of pain for day time relief while walking. Night splints when used in combination with stretching provides for a good static stretch at night to relief first step in the morning symptoms called post static dyskinesia. An added benefit of using a topical pain cream is the safety of not putting harmful chemicals in your mouth and body while helping alleviate heel pain.

Did my shoes cause my heel pain?

Changes in shoe gear can sometimes cause heel pain such as plantar fasciitis. The new shoe may not have enough structural integrity to support your foot in a proper manner. High heels and flip flops are notorious for causing foot and heel pain as they usually lack enough support for the foot.  Summer time can be a troubling time for people as they want to wear cute or flimsy shoes but they may be putting themselves at risk for developing heel and foot pain. Most foot doctors recommend a good lace up or tennis shoe to help prevent foot injury and fatigue. Our clinical physicians commonly recommend Pure Stride Inserts to their patient to be put in good shoes to make them better.  A good pair of inserts will control the heel to reduce fatigue in the foot. Most arch supports cannot be worn in sandals, clogs or flip flops.

What products will help my heel pain?

There are so many products on the market today to treat heel pain. How does a lay person know what will work and what is a bunch of hooey?  Our products on heelpainexpress have been approved and used by doctors to treat heel pain. They use these products daily in their practice as part of an effective treatment protocol for the recovery of plantar fasciitis. Product reviews can also be seen at heelpainfast.com an independent reviewer. A recent article in the Journal of Orthopaedic & Sports Physical Therapy, 2014 described similar treatments as are recommended on our site.