Each human foot has 33 joints, a network of more than 100 tendons, ligaments, and muscles, and 26 bones. The heel bone is the largest bone in the foot. The heel bone, just like all bones in the body, can be compromised by outside influences. These influences can hinder the bone’s integrity and its ability to support us on our feet. Heel pain, which can happen in the front, back, or bottom of the heel, can be so bad that it becomes disabling.
Causes of Heel Pain
There are many causes of heel pain. Normally, pain in the heels is a product of faulty biomechanics, which basically means that something in your foot isn’t doing its job correctly, causing walking gait abnormalities. These faulty biomechanics place an excess amount of stress on the heel bone and the surrounding/attached tissues.
Another common cause of heel pain is injuries or bruises gained while walking, running, or jumping on hard surfaces. Wearing flimsy flip-flops or other poorly constructed footwear can also cause heel pain. Being overweight can also lead to heel pain.
Specific Conditions that Cause Heel Pain
There are several conditions that can make your heel hurt. What follows is a description of each condition and a list of possible reasons why the condition exists.
Heel Spurs: Like the metal that protrudes from the back of a cowboy boot with the same name, heel spurs are growth that occur on the underside of the heel bone. The bony growths can stick out as much as half an inch. These spurs are visible through the use of X-rays. You may also hear this condition referred to as “heel spur syndrome” especially with there is no indication of bone enlargement. Heel spurs are caused by several things, including strain on the muscles and ligaments of the foot, stretching of the long band of tissue that connects the heel and the ball of the foot, and repeated tearing of the lining or membrane that covers the heel bone. The straining, stretching, and tearing can be due to biomechanical imbalances, running or jogging, shoes that are excessively worn or improperly fitted, and due to obesity.
Plantar Fasciitis: This condition is often connected with heels spurs and heel pain. Defined as an inflammation if the band of fibrous connective tissue (called the fascia) that runs along the bottom (called the plantar surface) of the foot. It connects the heel and the ball of the foot. This condition frequently occurs in athletes who run and jump often, and is can be a sign of the chronic irritation that an athletic lifestyle can produce. Plantar fasciitis can be quite painful.
The reason for the inflammation and pain is that the plantar fascia (the tissue) is strained beyond its normal extension, normally over time. This overextension causes the soft tissue fibers to tear and/or stretch. This tearing and stretching leads to inflammation, pain and possibly the growth of a bone spur near the heel. If you have shoes that fail to appropriately support your arch, the inflammation may be aggravated.
Resting your foot will only provide temporary relief. Especially after a night’s sleep, resuming walking may suddenly stretch the fascia band, which pulls at the heel. The pain may fade as you walk, but the pain will probably return after a prolonged rest or extensive walking.
Excessive Pronation: Pronation is flattening and normal flexible motion of the arch of the foot. This is how your foot adapts to ground surfaces and absorbs shock as you walk. Normally, your heel should hit the ground first as you walk. The weight should shift first to the outside of your foot, then move toward the big toe. The arch of your foot will rise, and the whole foot normally rolls upward and outward, staying rigid and stable in order to lift your body and move you forward. If for some reason, there is excessive inward motion during the walking process, the ligaments and tendons attached to the bottom back of the heel bone will stretch and pull, creating pain. Excessive pronation can affect and even cause injury to your hip, knee, and lower back.
Achilles tendinitis: Your Achilles tendon runs behind your ankles and connects on the back surface of your heel bone. When this tendon is inflamed, you get Achilles tendinitis. This often happens to people who run and walk a lot, especially if they already have tight tendons. It can also happen to people with tight tendons who don’t run or walk a lot. The Achilles tendon is strained over time, which causes the fibers in the tendon to stretch or tear, either long the tendon or where it is inserted on to the heel bone. These tears and stretching are painful, cause inflammation, and can cause heel spurs. You can aggravate the inflammation if you lead an active lifestyle and chronically irritate the tendon, or if you often do certain activities that can strain your tendon, especially if they are already tight.
The four conditions described above are some of the most common reasons for heel pain, but there are others, including:
- A bone bruise (contusion) This is a condition where the tissues that cover the heel bone become inflamed. Bone bruises are sharply painful, and are injuries that occur when you hit your foot with a direct impact with a hard object, like a table leg or the floor.
- An inflamed bursa (bursitis) The bursa in your feet are small sacs of fluid that help protect the ligaments, tendons, muscles, and bones in your foot. If they are irritated, or if there is a neuroma (a nerve growth) or another soft-tissue growth, the pain may feel like you have a heel spur, though you may not always have a spur.
- Haglund’s deformity (“pump bump”) This is a bone enlargement at the back of the heel bone. It occurs near where the Achilles tendon attaches to the bone. Often, this possibly painful deformity is caused by bursitis creating pressure against the shoe. It can be increased by the height or stitching of a heel counter in a particular shoe.
- Rheumatoid arthritis (or other forms of arthritis) can cause pain in the heel. Gout, which is a form of arthritis, can affect the heel, even though it usually shows up in the big toe joint.
When Should you Visit Us About Your Heel Pain?
If you feel that the pain is limiting your normal activities, or if the pain, redness, swelling, and heat (other symptoms of inflammation) are persistent, then you should make a visit to one of our Utah offices by calling us or requesting an appointment.
What Will We Do to Diagnosis and Treat Your Heel Pain?
We will first examine the area where you are experiencing pain, and may order X-rays to make sure it’s not a problem in the bone. If you are having problems with inflammation, your podiatrist may give you oral or injectable anti-inflammatory medicine. They will also help you make changes to the exercises you do and the shoes you wear to minimize new irritation. The podiatrist may also recommend taping or strapping the foot. This will support the foot, allowing the stressed muscles and tendons to rest and heal. Shoe inserts or orthotic devices can also assist your feet in healing and prevent new occurrences of the condition; orthotics can even correct biomechanical imbalances, stop excessive pronation, and support the ligaments and tendons in your foot. The orthotics should treat most heel and arch pains effectively without the need for surgery. They may also prescribe physical therapy.
If the recommendations above fail to solve the pain, more advanced treatments or surgery may be needed. Most foot pain can be corrected without the need for surgery. If it is needed, surgery could mean releasing the plantar fascia, removing a spur, removing a bursa, or removing a neuroma or other soft-tissue growth.
What Can You Do to Prevent Heel Pain and Plantar Fasciitis?
There are many things you can do to decrease your chances of heel pain and the conditions that cause it. Here are a few:
- Wear shoes that fit your feet. This fit needs to include the front, back, and sides. Your shoes should also have shock-absorbent soles, rigid shanks, and supportive heel counters. Make sure the shoes you are wearing are appropriate for the activity you are participating in. Avoid wearing shoes that have lots of wear on the heels or soles.
- When you exercise, make sure you prepare properly by warming up and doing stretching exercises before and after, especially when you go running or jogging. Make sure to pace yourself as you run or play in other athletics.
- Remember that your body needs good rest and good nutrition. If you are obese or overweight, attempt to shed some excess fat. Your feet function better when the load they lift is lighter.
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