Pain is always unpleasant and can deny us the pleasure of enjoying a good day, spending time with family and friends, and even the comfort that comes with rest. Heel pain is not an exception.
Most patients with foot and ankle disorders are among the majority that complain of heel pain. This kind of pain happens on the heel\’s back surface and sometimes on the plantar which is the foot\’s under surface.
Heel pain can slow down or ultimately impede movement causing you to seek medical attention. Heel pain treatment requires professional care and takes time to heal.
Symptoms Associated with Heel Pain
Some signs alert you when you have heel pain:
- Presence of pain between the arch and the heel. The pain increases every time you begin to walk and stops when you rest.
- Difficulty in raising your toes.
- When you stand at the tips of your toes, you feel pain in the calf. There is also a pain in the heel and ankle.
- Swelling and redness that increases with time.
- Having a hard time walking as a result of sharp pain or swelling.
- Snapping sounds when an injury occurs.
There are several conditions that may lead to heal pain. Some of these conditions include the following:
Sprain and Strains
The two words are synonymous to mean the tearing of tissues that connect two bones. The tearing is often due to overstretching and mostly happens at the ankle hence affecting the heel.
Fractures
A fracture is a broken bone due to unusual force or pressure exerted on a body. Causes range from gunshots, falling, accidents, and direct strikes to a part of the body.
The levels of a fracture begin from a crack in the bone to a completely cracked bone. The bone can have fractures in different places, it could break into several pieces, and it can split from any direction lengthwise or across.
A fracture can also tear into your skin, increasing the risk of infection. Anyone can get a fracture, however, older people, those with intestinal or endocrine disorders, and the physically inactive are at risk of getting a fracture.
Heel bumps
This condition is most common among teenagers. During teenage, the body gradually transitions from childhood to adulthood. However, some bones are not fully mature. If the bones experience excessive friction and rubbing, there is a possibility of having too much bone formation causing the bumps.
When a young person begins to wear heels before the bone is mature enough, they may experience this condition. People born with flat feet are prone to this disorder.
Plantar Fasciitis
The plantar fascia is a set of tissues that connect your heel and the front of your foot. It is thick, web-like, and acts as a shock absorber to protect the foot from light injuries. It allows you to arch your foot, thus enabling movement.
Typically, the tissues in the plantar fascia wear and tear very often. This process can be a result of an increase in pressure on the feet. Much stress can be harmful to the ligaments, resulting in tearing, inflammation, stiffness, and heel pain.
This disorder can affect the bottom middle part of the foot or the bottom of the heel. It may also occur on one foot, and in some cases, it happens on both feet.
The condition is predominant in women than in men. Among the women, those who are expectant are more likely to experience plantar fasciitis, especially during late pregnancy, due to increased weight and body pressure. Additionally, both men and women who are active and range between ages 40-70 are also at the risk of developing this disorder.
Plantar Fasciitis is common among long-distance runners or people whose jobs involve much walking.
A sudden increase in body weight, overweight, and obesity put you at a higher risk of suffering from plantar fasciitis. These factors increase the amount of pressure around your plantar fascia, forcing it to bear an unusual weight.
Rectrocalcaneal Bursitis
The retrocalcaneal bursa is a part of the leg behind the Achilles tendon. This disorder is a result of the swelling of the bursaes. These cells are filled with fluid and cushion the joints that conduct repetitive actions.
Exposure of the bursaes to too much pressure, the bursa swells and slowly becomes tender, causing pain over time. The heels become achy, and there is so much discomfort when wearing shoes or standing with the toes.
The condition calls for urgent medical attention as it can become septic causing fever and chills.
vi. Achilles Tendon
Tendons, like any other part of the body, play a very crucial role in the body. Its functions in the musculoskeletal system involve the transfer of loads from muscles to bones. These functions allow for joint motion and stability.
The Achilles tendon joins the calf muscles to the calcaneus. This coordination allows you to stand on your feet, jump, walk, and run. The tendons\’ ability to adapt to load changes by producing more collagen allows the body to endure long physical exercises.
As we continue to age, our bodies cannot generate new cells; hence the older ones wear out and become weak. Since this is a slow process, indulging in strenuous or intense physical exercise causes the tendons to wear out very fast. The tendons experience inflammation and become very painful. Unfortunately, the process is irreversible.
There are two types of Achilles tendonitis. The insertional Achilles tendonitis affects the lower part of your tendon, which attaches to the heel bone. The second is the non-insertional Achilles tendonitis that affects the fibres in the middle of the tendons.
Ways of Preventing Heel Pain
Heel pain can prevent you from having a normal daily routine hence affecting your life.
- Maintaining a proper and healthy weight.
- Warm up before exercise to allow your muscles to stretch and get ready for activity.
- Always wear the right shoes, whether at home, work, or during physical exercise. They should support your feet and fit correctly.
- Eat healthily
- Train your body to rest especially when you are exhausted and when you experience muscle aches.
- Take breaks in between physical activities.
- If it is not a work requirement, avoid wearing heeled shoes. If you must, then reduce the hours you spend in them or alternate between low heeled shoes, flat shoes, and the heeled shoes.
When to Call a Podiatrist
Some home procedures can help relieve heel pain. However, there are cases where one is advised against administering first aid, and if there are cases when you need to call your podiatrist or visit your GP.
- Persistent pain
- Discoloration of the affected area
- An infection is elaborate when there is swelling, redness, or fever.
Diagnosing Types of Heel Pain
Heel pain diagnosis requires an assessment of prior medical history and clinical examination.
History
The patient\’s medical history helps the doctor understand what could be the etiology of the heel pain. To attain a detailed answer, the doctor or physician will ask several questions. Some of the usual problems include:
When did the pain begin? Have you visited a doctor before, and what was the treatment used? Are there people from your family with a history of heel pains? How long does the pain last? What times does the pain occur more frequently? Is the pain triggered by carrying a heavy load?
Have you had traumatic stress in the recent past? Which are the other symptoms that you are experiencing other than heel pain? Is the heel numb, swollen, or with a fever or burning sensations? Is the pain over or above the heel? Is there a recent history of weight gain? Have you ever had a fracture?
The patient\’s history allows the physician to comprehend the nature of the pain and activities that trigger the pain.
Instances that depict the patient\’s pain for long durations or with persistent ambulation indicate the possibility of a fracture, entrapment neuropathies, cyst, or calcaneal tendon tear. Short pain periods with improvements with ambulation could predict plantar fasciitis or mild nerve entrapment.
Increased pain due to vigorous activities indicates a fracture, calcaneal cyst, tendon tear, or nerve entrapment. Where short durations of ambulation ease the pain, you should consider fasciitis or frequent causes of heel pain.
If there is a consistent family history of heel pain, you should consider checking for arthritis. Traumatic occurrences may cause heel pain due to fractures, fascia, or tendon tears.
Clinical examination
The medical examination helps to prove that the suspected problem is the cause of heel pain. It also helps the physician rule out diseases with only a few symptoms and administers the correct treatment. A health care provider uses palpation to determine the tenderness, size, shape, and location of the pain.
A doctor will check for scars, lumps, bruises, or swellings. When using percussion, the physician can discern neuromas and examine the stiffness of the Achilles tendon.
Examining the skin for abnormal patches around the ankle, elbow, and knees indicates psoriasis. Soft tissue masses may signify psoriatic or rheumatoid arthritis. Varicosity is a possible origin of heel pain where soft tissue masses occur around the tarsal tunnel pushing the nerve.
A positive tinel test on the heel, particularly on the distal nerve, signifies tarsal tunnel or calcaneal nerve entrapment. To help doctors narrow down the exact disease, they use several tests and methods.
a. Laboratory test
Lab tests help show the cause of pain, whether by infections such as cysts or injuries and ruptured tendons. The C-reactive protein (CRP) test is the most popular instruction to rule out infections.
b. Image test
- Use of radiographs such as the X-RAY help to show fractures, Haglund syndrome, or bone tumors.
- Magnetic resonance imaging (MRI) helps to distinguish tendon inflammation of paratenon, bursitis, and tendinosis. MRI is used for soft tissue diagnosis of injuries or infections. MRI is also popular in the diagnosis of nerve issues.
- The three-phase bone scan is useful in highlighting the area with tremendous pain.
- Computed tomography (CT) scan gives detailed results about arthritis, stress fractures, and calcaneal cysts. CT scans help to distinguish arthritis conditions caused by abnormal gait from plantar heel pains.
- The ultrasound helps to rule out cyst infections from pain caused by deep vein thrombosis (DVT).
- Electromyography (EMG) and nerve conduction study (NCS) help locate and show the extent of nerve and muscle damage.
Treatment of Heel Pain
Heel pain treatment range from conservative management to surgery. However, you must consult with your physician to know which treatment method best works for you.
Resting
Prevent having lots of weight on your feet when you have burning sensations or inflammations. The reduced weight helps the heels to get relief and heal faster.
Sometimes severe pain is caused by vigorous activities such as walking for long distances, running, or jogging. Keep off such activities until the pain subsides.
Physical Exercises
Doing regular foot exercises such as the heel cord stretch and calf stretch help to overcome heel pains. Try to lift your body while on your toes morning and evening at least twelve times each session.
Orthotic Therapy
The therapy entails weights customized for your shoes to attain feet stability and control excessive foot movements. Some of the custom shoes are wedge-shaped with a weight attached to the sole to help stretch the ankle muscles. Patients with Achilles tendonitis use these types of shoes.
Resting splints also help to cure heel pain. Patients strap the resting splints on their feet at night. They prevent the contraction of plantar flexion while you are sleeping due to relaxation. The resting splints help to cure plantar fascia, but caution is required to remove them before you get out of bed due to the slippery sole.
Different heel heights help to correct Haglund syndrome. Using gel pads and heel cups help to reduce the pain caused by plantar fasciitis.
Icing your Feet
Ice helps to treat plantar fasciitis by reducing inflammations to your feet. To do this, create an ice pack by wrapping a towel around plastic bags full of ice cubes. Insert your feet into the ice pack three to four times a day for about 15 to 20 minutes each time.
You can also use ice slippers, which you place in the freezer, and strap them on for about 5 to 10 minutes when you need relief.
Tapping
Hypoallergenic tapes or kinesiology tapes help to reduce pain and drive the pressure off the plantar fascia. Tape assists in adding support beneath your feet. Tapping is easy and requires you to stretch out your feet and wrap the tap around without allowing any tension on the upper part of your feet.
Medication
Patients reduce swelling and relieve pain through nonsteroidal anti-inflammatory drugs (NSAIDs).
Cortisone injection is a temporal solution in reducing pain. Prolonged use of the drug leads to adverse negative effects.
Extracorporeal shockwave therapy
Injections with platelets-rich plasma (PRP) treat plantar fasciitis as the necessary environment for growth essential for healing.
Surgery
Surgery comes in when all the above measures have failed in a period of over one year. Longitudinal tenotomies surgeries reduce the length of the tendon. Through surgery, we can remove Haglund deformities. Doctors add flexor hallucis longus or plantaris when the tendon is too weak.