There are two categories of Heel Pain
. pain on the bottom (plantar) and pain on the back of the
heel bone (calcaneus). The most common cause pain on the bottom of the heel is plantar fasciitis or better known as heel spur syndrome. Another common cause is nerve entrapment (~70% of patients have
both plantar fasciitis and nerve entrapment) and less commonly, stress fracture, arthritis, tendonitis, a cyst or a combination of these. Pain on the back of the heel most often involves the
insertion of the Achilles tendon into the bone. Due to the multi-factorial nature of heel pain, the earlier a diagnosis is made, the better the outcome.
Plantar fasciitis: It is the most common cause of heel pain. In this condition, the pain is more severe in the morning but becomes less painful as the day continues. It occurs due to tiny tears in
the plantar fascia.The plantar faschia is a tissue band that connects the bottom of the heel bones to the ball of the foot and is involved in walking and running, giving spring to the step. If left
untreated, the symptoms usually worsen and can lead to problems with the knee and hip and can cause back pain due to difficulty walking. Those who frequently stand or walk throughout the day or those
who run are most likely to develop plantar fasciitis.
Depending on the specific form of heel pain, symptoms may vary. Pain stemming from plantar fasciitis or heel spurs is particularly acute following periods of rest, whether it is after getting out of
bed in the morning, or getting up after a long period of sitting. In many cases, pain subsides during activity as injured tissue adjusts to damage, but can return again with prolonged activity or
when excessive pressure is applied to the affected area. Extended periods of activity and/or strain of the foot can increase pain and inflammation in the foot. In addition to pain, heel conditions
can also generate swelling, bruising, and redness. The foot may also be hot to the touch, experience tingling, or numbness depending on the condition.
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
When consulting a doctor about heel pain, a patient can expect to be questioned about their level of pain, how long they?ve been experiencing it, and which activities aggravate or alleviate the
condition. The doctor may order x-rays, a physical therapy regimen, or refer the afflicted individual to an orthopedic specialist for further examination. The doctor may attempt to recreate
conditions that cause the heel pain to flare up in order to study reaction and cause in the patient, but this will be temporary and the doctor will stop this test at the request of the patient. A
patient with heel pain may also be fitted with special inserts for their shoes to help correct arch and heel problems that cause pain. Heel problems can range from the mildly irritating to the nearly
devastating, but proper prevention in care will help keep each step pain free. Advanced orthopedics, pain management, and technologically-honed surgical techniques ensure that no patient needs to
suffer with the discomfort of heel pain and the restrictions it imposes on an active lifestyle.
Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver
high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a
"numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National
Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are
uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies
found the procedure to be no better than a placebo (sham treatment).
It may not be possible to prevent all cases of heel pain. However, there are some easy steps that you can take to avoid injury to the heel and prevent pain. Whenever possible, you should wear shoes
that fit properly and support the foot, wear the right shoes for physical activity, stretch your muscles before exercising, pace yourself during physical activity, maintain a healthy diet, rest when
you feel tired or when your muscles ache, maintain a healthy weight.