| Heel Pain
Relief for Painful,
Inflamed Heels
Sharp pain, aching or
stiffness on the bottom of one or both heels is a very
common ailment. The pain is often at its worst upon
awakening in the morning (or after sitting down for an
extended period and then resuming activity), causing
hobbling or limping for a few minutes before a comfortable
stride can be resumed. As weight continues to be applied
during walking or standing, mild or severe pain may
persist.
Adults-whether office worker,
laborer or athlete develop the problem most frequently,
although children, too, can be affected if the growing
bone becomes irritated.
Causes of
Heel Pain
Heel pain originates deep
within the foot, directly on the heel bone or within the
foot's connective tissues, called the fascia.
Several layers of fatty
tissue surround the heel bone, softening the impact or
walking and running and protecting the bones and muscles
of the foot. Beneath this padding, a fibrous band of
connective tissue (the fascia) extends from the heel bone,
supports the arch and reaches across to the toes. Pain can
result when these tissues become irritated or inflamed, or
when small spurs grow on the heel bone.
Inflammation
Most cases of heel pain are
characterized by inflammation. First, the fascia begins to
pull on the bone and the tissues become irritated, then
inflamed. Inflammation of the fascia is called fascitis.
Heel Spurs
A projection or growth of
bone may be called a spur, and can grow where the muscles
of the foot attach to bone. While some heel spurs are
painless, others that are determined to be the cause of
chronic heel pain may require medical treatment or
surgical removal (see "Surgical Treatments for
Heel Pain").
Other Causes
While injury, overuse or
other temporary, mechanical causes can bring on discomfort
in the heel, a painful heel may also accompany a more
serious condition, such as:
 | Gout
| Arthritis
| Psoriasis
| Collagen disorders
| Nerve injuries
| Heel bone abnormalities
| Tumors |
| | | | | |
Illnesses like these and
others must be diagnosed and treated separately. Your
podiatric surgeon may refer you to a local specialist if
the problems are beyond his or her area of expertise.
Caring for the
Painful Heel
In most cases, heel pain can
be relieved without surgery. Treatment may include
self-care, medications, therapy or orthotics.
Self-Care
Several steps can be taken to
care for a painful heel at home.
| Take medications that
contain ibuprofen or aspirin daily as directed, for as
long as symptoms persist, to help reduce tissue
inflammation.
Follow dosage directions carefully. As with any
medication, be aware of potential allergic responses
and discontinue use if any adverse reaction occurs, or
if pain is not relieved after several days' use.
| Soak the heel in ice water
to relieve pain and inflammation. This works best by
placing the foot in a basin filled with tap water,
high enough to cover the heel. Allow the foot to
adjust to this temperature. Then add ice cubes (two or
three at a time) every five or six minutes over a
30-minute period. Soak the foot in ice water three
times daily and immediately after any activity. Heat
may also be recommended, but ice is usually
preferable.
Caution: People with diabetes or poor circulation
should not use cold water or ice packs.
| Avoid sports and other vigorous
activities while healing.
| Wear higher heeled shoes
and choose shoes with heels made from soft rubber
instead of leather. Running shoes are often the most
comfortable.
| Stretch the calf muscles
daily. |
| | | |
Nonsurgical Medical
Treatments
If self-care measures do not
relieve the pain, the podiatric surgeon may recommend
various treatments to reduce inflammation. Some of these
may include:
| Prescription oral
nonsteroidal anti-inflammatory medications to reduce
both pain and inflammation.
| Cortisone injections
| Foot taping and padding
| Physical therapy - The
podiatrist or physical therapist may treat heel pain
with ultrasound, electrical stimulation or
hydrotherapy. Each of these methods may help reduce
inflammation.
| Custom orthotics - A foam
or plastic orthotic (custom-made to fit the foot) can
often relieve the strain on the tissues and permit the
heel to recover. |
| | | |
Surgical Treatments for
Heel Pain
If nonsurgical medical
treatments fail and pain persists, surgical intervention
may be necessary.
Both surgical procedures
described below are usually completed on an outpatient
basis in less than one hour. They are performed
comfortably under either local anesthesia or minimal
sedation administered by trained personnel.
Removal of
Connective Tissue (Fascia)
During surgery to separate
all or a portion of the fascial tissue from the heel bone,
the podiatric surgeon will make a small incision on the
inside of the heel. Then, the tissue is carefully cut away
(see illustration A). A few stitches will be required.
Bone Spur Removal
Heel spurs may be removed
during the same operation for separating the connective
tissue from the heel bone.
After the tissue has been
detached, the podiatric surgeon will remove any spurs,
leaving the heel bone smooth (see illustration B).
Postoperative Care
Immediately after either
operator, a plaster cast may or may not be used to support
and immobilize the foot for two to three weeks. Crutches
may be helpful for greater comfort and mobility while the
foot heals.
When the cast has been
removed, three to four weeks of physical therapy will
speed healing and reduce swelling.
Provided there are no
complications, recovery is usually complete in six to
eight weeks.
When Can Usual Activities
Be Resumed?
Normal daily activities can
be gradually resumed as soon as pain subsides, or when
recommended by the podiatric surgeon. Within a few days
after surgery, most people begin moving comfortably. As
recovery continues, activities can gradually increase.
How Can Heel Pain Be
Prevented? Unfortunately, prevention is not always
possible. If pain is related to too much activity or an
abnormal foot structure (such as flat feet or high
arches), modifying the daily routine to exclude activities
that are stressful on the feet, should be considered. For
example, jogging should be replaced with biking and/or
swimming. If symptoms of heel pain develop, icing the foot
should begin immediately. |
