As anyone who has ever had foot pain can tell you, when your feet hurt, you hurt all over. ?The feet are the foundation of our ?building,? or body,? says Craig Gastwirth, a podiatrist at Podiatry
Examiners of Michigan in Detroit. If there's a problem with that foundation, everything else - knees, hips and back - is thrown off. Heel Pain
, typically caused by plantar fasciitis, is the No. 1 reason people visit a podiatrist,
says Dr. Gastwirth. Plantar fasciitis, inflammation of a thick band of connective tissue called the plantar fascia, which runs along the sole from the bottom of the heel bone to the toes, can feel
like the arch of the foot is tearing.
Heel pain is a common symptom that has many possible causes. Although heel pain sometimes is caused by a systemic (body-wide) illness, such as rheumatoid arthritis or gout, it usually is a local
condition that affects only the foot. The most common local causes of heel pain include Plantar fasciitis. lantar fasciitis is a painful inflammation of the plantar fascia, a fibrous band of tissue
on the sole of the foot that helps to support the arch. Plantar fasciitis occurs when the plantar fascia is overloaded or overstretched. This causes small tears in the fibers of the fascia,
especially where the fascia meets the heel bone. Plantar fasciitis may develop in just about anyone but it is particularly common in the following groups of people: people with diabetes, obese
people, pregnant women, runners, volleyball players, tennis players and people who participate in step aerobics or stair climbing. You also can trigger plantar fasciitis by pushing a large appliance
or piece of furniture or by wearing worn out or poorly constructed shoes. In athletes, plantar fasciitis may follow a period of intense training, especially in runners who push themselves to run
longer distances. People with flat feet have a higher risk of developing plantar fasciitis. Heel spur. heel spur is an abnormal growth of bone at the area where the plantar fascia attaches to the
heel bone. It is caused by long-term strain on the plantar fascia and muscles of the foot, especially in obese people, runners or joggers. As in plantar fasciitis, shoes that are worn out, poorly
fitting or poorly constructed can aggravate the problem. Heel spurs may not be the cause of heel pain even when seen on an X-ray. In fact, they may develop as a reaction to plantar fasciitis.
Calcaneal apophysitis, n this condition, the center of the heel bone becomes irritated as a result of a new shoe or increased athletic activity. This pain occurs in the back of the heel, not the
bottom. Calcaneal apophysitis is a fairly common cause of heel pain in active, growing children between the ages of 8 and 14. Although almost any boy or girl can be affected, children who participate
in sports that require a lot of jumping have the highest risk of developing this condition. Bursitis. ursitis means inflammation of a bursa, a sac that lines many joints and allows tendons and
muscles to move easily when the joint is moving. In the heel, bursitis may cause pain at the underside or back of the heel. In some cases, heel bursitis is related to structural problems of the foot
that cause an abnormal gait (way of walking). In other cases, wearing shoes with poorly cushioned heels can trigger bursitis. Pump bump. his condition, medically known as posterior calcaneal
exostosis, is an abnormal bony growth at the back of the heel. It is especially common in young women, in whom it is often related to long-term bursitis caused by pressure from pump shoes. Local
bruises. ike other parts of the foot, the heel can be bumped and bruised accidentally. Typically, this happens as a "stone bruise," an impact injury caused by stepping on a sharp object while walking
barefoot. Achilles tendonitis. n most cases, Achilles tendonitis (inflammation of the Achilles tendon) is triggered by overuse, especially by excessive jumping during sports. However, it also can be
related to poorly fitting shoes if the upper back portion of a shoe digs into the Achilles tendon at the back of the heel. Less often, it is caused by an inflammatory illness, such as ankylosing
spondylitis (also called axial spondylarthritis), reactive arthritis, gout or rheumatoid arthritis. Trapped nerve. ompression of a small nerve (a branch of the lateral plantar nerve) can cause pain,
numbness or tingling in the heel area. In many cases, this nerve compression is related to a sprain, fracture or varicose (swollen) vein near the heel.
See your doctor immediately if you have Severe pain and swelling near your heel. Inability to bend your foot downward, rise on your toes or walk normally. Heel pain with fever, numbness or tingling
in your heel. Severe heel pain immediately after an injury. Schedule an office visit if you have. Heel pain that continues when you're not walking or standing. Heel pain that lasts more than a few
weeks, even after you've tried rest, ice and other home treatments.
To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain
other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are
found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
Non Surgical Treatment
Depending on the underlying cause, treatment can include. Rest from activities that stress the heel (such as running and jumping). Ice packs. Regular foot massage, concentrating on the arch of the
foot. Professional strapping. A splint worn at night. Flexibility exercises. Ultrasound therapy. Anti-inflammatory medicine (topical or oral). Checking your posture and walking style, to correct
imbalances and gait abnormalities that may contribute to the pain. Shoe inserts (orthoses) to help support the foot. In some cases, surgery may be recommended to treat conditions including neuroma,
bursitis and heel spurs.
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.
Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising. Wear comfortable, properly fitting
shoes with good arch support and cushioning. Make sure there is enough room for your toes.