Heel Pain

Introduction

Here at the Markham Foot Care Clinic we know two things for sure:

• Heel pain is never normal
• You do not have to suffer from heel pain

Heel pain and arch pain are the most common foot injuries that we see at Markham Foot Care Clinic and Orthotics. It is experienced by people of all ages, including children, people who stand all day, athletes, and seniors. Anyone can get heel pain!! Heel pain can be effectively treated and prevented. Do not wait until your heels hurts so much that you can hardly walk. The sooner you treat your heel pain, the faster the pain will go away allowing you to return to your active lifestyle.

What common terms are used to describe HEEL PAIN?

• Heel spurs
• Heel spur syndrome
• Bone spur
• Heel pain
• Arch pain
• Plantar fasciitis
• Achilles tendinitis
• Bruised heel

Most people will experience heel pain in either the arch of the foot, the bottom of the heel or the back of the heel.

ARCH PAIN AND HEEL PAIN

The heel bone or calcaneus is the largest bone in the foot. Although it is a very sturdy bone it often becomes injured due to the amount of body weight it must bear throughout the day. The pain it is capable of causing can be very disabling. The pain can be come so severe that people are unable to place any weight on the foot at all. The most common cause of heel and arch pain is plantar fasciitis, which is an inflammation of the plantar fascia. The plantar fascia a very strong band of fibrous tissue, similar to a ligament, that runs along the bottom surface of the foot from the heel bone to the toes. The plantar fascia is located just below the skin and helps to support the arch of the foot.

What are the symptoms of plantar fasciitis?

Pain from plantar fasciitis can be felt anywhere along the arch of the foot, however, it is generally felt in the bottom of the heel and usually gets worse over a period of months. People with plantar fasciitis usually complain that they have a sharp stabbing pain in the heel when they first get out of bed in the morning or when they stand up after they have been off their feet for a while. The pain often goes away after a few minutes of walking because walking stretches the plantar fascia. For some people the pain returns after spending long periods of time on their feet or later in the day.

What are the common causes of heel pain and plantar fasciitis?

• Research shows that most cases of plantar fasciitis are directly related to structural imbalances within the feet and lower limbs. People who have excessive flattening of the arch on weight bearing or tightness in the plantar fascia from high arches tend to be prone to plantar fasciitis due to the pulling of the plantar fascia on the heel bone
• Plantar fasciitis can be aggravated by wearing non supportive footwear such as flip flops, slip-on shoes and slippers, and by the chronic irritation of the fascia from jobs that require long term standing on hard surfaces such as concrete.
• Women in their 40’s and 50’s tend to get plantar fasciitis more often
• Athletes and those who exercise on a regular basis are also more prone to plantar fasciitis

How do you treat heel pain and plantar fasciitis?

The treatment of plantar fasciitis can begin at home:

• Rest will allow the inflammation to settle down. Standing, walking and any running should be avoided as every step aggravates the injury. Swimming and biking can replace running as a form of exercise.
• Wear supportive shoes such as jogging shoes with firm midsoles, rigid heel counters and laces. The shoes should be worn in the house. You should avoid going bare foot or wearing slippers or sandals.
• Inflammation is reduced by applying ice to the heel or arch for 10 minutes 2-3 times daily.
• Exercises that help stretch the calf muscle may help to relieve the pain.

If you still have pain after a week or so call our office and we can add one or more of the following treatments:

• Taping your foot to maintain the arch will take the tension off the inflamed plantar fascia and provides short term relief in acute situations. The tape is worn for a week and is re-taped on a weekly basis
• Anti inflammatory medications can be prescribed. They can play an important role in reducing the inflammation and reducing the pain on a short term basis.
• Plantar fasciitis night splints are splints that are designed to be worn at night when you sleep. They work by stretching the inflamed plantar fascia as you sleep.
• Physical therapy modalities such as ultrasound and laser therapy
• In some cases a corticosteroid (Cortisone) injection helps to reduce the inflammation and pain. We do not inject into the bottom the heel which is very painful. All our injections are given through an injection from the side of the heel with a fine gauge thin needle. This approach has proven to be much less painful and is generally well tolerated by patients over the traditional injection into the bottom of the foot in the middle of the heel.
• Custom made foot orthotics are a critical part of the treatment plan and are often the key to successful treatment of heel pain. Custom foot orthotics are prescription medical devices that are made from a mould of the foot. Orthotics are removable devices that are fitted under your feet and are worn inside your shoes and can be transferred from shoe to shoe. They are designed to adjust and control the functions of the foot and its alignment with the lower leg.

How do I prevent my heel or arch pain from coming back?

No matter what type of treatment you have for plantar fasciitis, the underlying imbalance that lead to this condition will remain. With this in mind you will need to continue with preventive measures once your pain improves. Wearing custom foot orthotics and proper footwear are the most important long-term component in the prevention of the reoccurrence of heel pain and plantar fasciitis.

A word of caution about custom foot orthotics

Many different kinds of in shoe devices are now being referred to as orthotics. You will see orthotics in infomercials on television, stands at consumer shows and in a growing number of retail stores. Arch supports sold in drug stores and shoe stores are increasingly being referred to as orthotics. If there is no cast taken your orthotic is likely not custom made. Pain is the body’s way of telling you that something is wrong. Generally the worse the pain is the worse the problem is. If your heel pain still persists after a week or so of home treatment call our office at 905 294 8087 and we will do our best to end your pain and get you back to the activities that you enjoy.

I had an X-ray of my foot and have been told that I have a heel spur. What is this?

A heel spur or bone spur is a growth of bone that develops where the plantar fascia attaches to the heel bone or calcaneus. The heel spur is caused by long term strain on the plantar fascia at the point where it attaches to the heel bone. This strain causes a spur of bone to grow in the direction of the pull from the plantar fascia. Heel spurs often develop over many years and are usually occur in people with mechanical imbalances in their feet combined with factors such as standing on concrete, being overweight and wearing improper footwear. The important thing to remember about heel spurs is that many people have heel spurs and have no heel pain and many people with severe heel pain have no heel spur. It is the soft tissue or the plantar fascia that attaches to the heel spur that is causing all the pain. Treatment is therefore directed toward controlling the imbalances with foot orthotics and treating the painful and irritated soft tissues that are actually causing the pain.

PAIN IN THE BACK OF THE HEEL

Many people have heel pain in the back of the heel. While there are many causes of pain in the back of the heel it is most commonly caused by inflammation of the Achilles tendon either in the tendon itself or where it attaches on the back surface of the heel bone. This condition is known as Achilles tendinitis. It is very common in people who have short or tight Achilles tendons who play sports and those who are either running or walking for exercise. Like plantar fasciitis, Achilles tendonitis is an inflammation of the tendon that is caused by stress or strain on the tendon leading to swelling and pain.

HOW CAN I PREVENT HEEL PAIN?

• Wear supportive footwear if you plan to be on your feet a great deal. The shoes should have laces, a firm cushioned sole and a broad heel no more than an inch high.
• Avoid walking for long periods of time in thongs, flip fops, loose slip-ons or thin soled shoes. These types of shoes cause stress on your your feet which may cause the plantar fascia to become inflamed which can lead to heel pain. The heel can also become bruised due to lack of cushioning and the constant pounding from walking, so a cushioned sole will help.
• Choose the correct shoe for the activity. If you are running or walking make sure you wear a jogging shoe. Heel pain often begins when starting a new activity or sport such as jogging or walking especially if you are not wearing the correct type of shoe.
• Make sure you wear proper shoes at work as well. If you have to wear high heels or dress shoes at work you should change into proper footwear at lunch or when going to and from work. High heels will cause the calf muscles to shorten which can lead to heel pain.
• Replace your shoes regularly. Heel pain is often caused by running or walking in worn out shoes. For example, most jogging shoes should be replaced after running 500 – 600km. The sole of the jogger may not look worn but the mid sole (the section between the sole and the insole) often becomes compressed causing it to lose its support and cushioning.
• If you are not sure about which type of shoe you should be wearing consult a specialty running shoe store or seek a consultation with a chiropodist or podiatrist. We all have different feet so we all need different types of shoes. High arched feet and low arch feet benefit from different types of shoes.
• Before you exercise make sure you warm up properly. Stretching exercises should be done before and after exercise. A tight Achilles tendon is often the cause of heel pain. You should hold a stretch for at least a minute. If you wear high heels stretch your calf muscles as often as you can
• If you are overweight try to reduce your weight.
• If you wear your shoes out unevenly or wear them out quickly or if you have any foot pain you should see a chiropodist or podiatrist to prevent future foot problems

A word about self treatment of heel pain

The treatment of your heel pain is based entirely on the cause of the problem. Since there are many causes of heel pain you should understand the cause of your symptoms. If you are not sure of your diagnosis you should seek medical advice before you start treating yourself. Some common ways to treat heel pain are listed here and may not be appropriate for you.