Causes of Heel Pain
There are many ways to prevent and resolve the issues which cause heel pain. The solutions do not have to be strictly traditionally medical in nature. Pain in the heel impacts the whole area from the bottom of the foot to the back of the heel. The most common cause of pain which affects the bottom of the heel is plantar fasciitis. When there is pain which affects the back of the heel, it is likely due to Achilles tendinitis. Heel pain can cause problems with daily activities, such as walking and exercise. There are many other causes of heel pain, in addition to the aforementioned conditions, which includes arthritis, neuropathy, fractures, tarsal tunnel syndrome, gout, bursitis, heel spurs, osteomyelitis, and more.1
Heel pain can occur easily, even without a preexisting condition: Every mile that a patient walks puts about 60 tons of total stress on each foot. Exercising or walking on hard surfaces can irritate the heel. Continuing with stressful activities with an injured heel can lead to the development of further problems. When injury occurs, patients will often compensate by walking in an unusual manner or leaning their body to take the weight off of the injured foot. Whether or not they are doing this consciously, compensation could lead to the development of further injury or misalignment in other areas of the body.
One type of injury under the heel is a “stone bruise”. This injury develops due to stepping onto a hard object, such as a stone. The fat pad of the heel becomes bruised in this situation. The bruise becomes aggravated with every step that the patient takes. Wearing shoes that fit improperly and rub the back of the heel, or running too much, can trigger back of the heel pain, such as Achilles tendinitis. A surface abrasion could also begin to develop from wearing ill-fitting shoes which repeatedly wear down the skin on the heel.
A heel spur is a calcium deposit, caused when plantar fasciitis is not resolved. Plantar fasciitis can occur when running and jumping lead to inflammation of the fascia (tissue band) that connects the heel to the toes.2 Wearing worn-out shoes and flip flops, which do not provide the necessary proper arch support, can also be a cause of plantar fasciitis.3 Twisting the foot, or overpronation, can also stress the fascia.4
If there is fever accompanying the heel pain, along with numbness or tingling, it is important to seek treatment. Other reasons to get medical care would be if the heel pain comes after an injury and is severe, if the foot cannot bend down, if the patient is unable to walk normally or stand on their toes, or if there is swelling near the heel.
Typical home treatment would begin with RICE (rest, ice, compression, and elevation). Heel pain could also be resolved if the patient wears properly-fitted and supportive shoes. Foot supports, or orthotics, would also be helpful for creating additional, customized support. Heel cups and wedges can be found over-the-counter, or it may be worthwhile to invest in custom orthotics (i.e., Foot Levelers). Though the latter is more expensive, it is also personalized specifically to each patient’s foot, which means that it is more likely to be effective. It is not uncommon for people to use pain medications, such as ibuprofen or aspirin, to relieve the pain and reduce inflammation. However, depending on the situation, pain medication might do little more than mask the pain, as some conditions require more attention than the reduction of inflammation.5
Special stretching exercises and shoe inserts (such as heel pads) can relieve plantar fasciitis and heel spurs. It is often a recurring condition which requires that the patient learn the proper stretches for relief and wear supportive shoes to prevent a flare-up of pain. Achilles tendinitis may also require a heel insert, as well as special stretches, NSAID (nonsteroidal anti-inflammatory) medication, and icing.6 Orthotic insoles can help support the arch, resolving causes of heel pain. Besides stretching, patients may also be told to not walk barefoot (and to avoid flip flops). They should wear supportive footwear all day long and change worn-out shoes. Some doctors will use shock wave therapy, an ultrasound beam that can reduce inflammation, or even low-level lasers. Surgery is rarely necessary.7
Masking the heel pain with medication, such as NSAIDS or corticosteroids, is only a short-term fix to the problem. Chiropractors can provide very successful treatment options for heel pain. Plantar fasciitis may respond well to soft tissue manipulation and home exercises.8 Chiropractic care can also offer a stretching regimen. The chiropractor may recommend custom orthotics as well. Night splints may also be required to help protect the patient from involuntarily flexing their ankles during sleep which could contribute to their pain otherwise.9
1, 5 http://www.mayoclinic.com/health/heel-pain/MY00081
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