The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside
influences that can affect its integrity and its ability to keep us on our feet. Heel Pain
disabling, can occur in the front, back, or bottom of the heel.
Age plays a large role in the development of heel pain, particularly among those over 40. Being active is also a common factor of heel pain. Over time, the elasticity of the tissue in our feet
decreases with age, causing us to become prone to damage and also slowing the body's ability to heal damage. Adolescents are also not immune to heel pain. Those who are active in sports are
particularly prone to excessively stretching or straining the plantar fascia or Achilles tendon, causing severe heel pain. In most cases, heel pain develops in only one heel. There are many risk
factors that lead to heel pain. Abnormal gait and excessive, repetitive stress are common factors in the development of pain and damage. Among the other risk factors involved with the development of
heel pain are repetitive exercise or activities, such as long distance running or jumping from activities such as basketball. Obesity. Walking barefoot on hard surfaces. Prolonged standing. Wearing
poor fitting shoes, or shoes that do not provide enough support or cushioning. Not stretching properly or at all before and after exercise. Those who are on their feet for long periods of time.
The heel can be painful in many different ways, depending on the cause. Plantar fasciitis commonly causes intense heel pain along the bottom of the foot during the first few steps after getting out
of bed in the morning. This heel pain often goes away once you start to walk around, but it may return in the late afternoon or evening. Although X-ray evidence suggests that about 10% of the general
population has heels spurs, many of these people do not have any symptoms. In others, heel spurs cause pain and tenderness on the undersurface of the heel that worsen over several months. In a child,
this condition causes pain and tenderness at the lower back portion of the heel. The affected heel is often sore to the touch but not obviously swollen. Bursitis involving the heel causes pain in the
middle of the undersurface of the heel that worsens with prolonged standing and pain at the back of the heel that worsens if you bend your foot up or down. Pump bump, this condition causes a painful
enlargement at the back of the heel, especially when wearing shoes that press against the back of the heel. Heel bruises, like bruises elsewhere in the body, may cause pain, mild swelling, soreness
and a black-and-blue discoloration of the skin. Achilles tendonitis, this condition causes pain at the back of the heel where the Achilles tendon attaches to the heel. The pain typically becomes
worse if you exercise or play sports, and it often is followed by soreness, stiffness and mild swelling. A trapped nerve can cause pain, numbness or tingling almost anywhere at the back, inside or
undersurface of the heel. In addition, there are often other symptoms, such as swelling or discoloration - if the trapped nerve was caused by a sprain, fracture or other injury.
The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present
and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.
Non Surgical Treatment
Physical medicine modalities are well known for their benefits and they have been consistently applied in early treatment of plantar fasciitis. Typically, the direct application of ice, ice baths or
contrast soaking aid in the local reduction of inflammation and temporarily augment pain management. Electric stimulation may only provide indirect reduction of interstitial inflammation of the
plantar fascia. Ultrasound therapy, hot pack systems and deep tissue massage help eliminate inflammation and aid in restoring plantar fascia tensegrity. Generally, these modalities are considered to
be valuable adjuncts to a well-organised treatment plan. Various programs of stretching, range of motion and therapeutic exercises can help re-establish foot function and improve tolerance to load.
When it is done appropriately, stretching can serve as an important adjunct to the resumption of the plantar fascia?s ability to tolerate eccentric loading forces that typically occur during stance
and gait. Night splinting has proven to be an effective tool in managing persistent plantar fasciitis. Antiinflammatory modalities, such as ice and ice baths, are often the first line of treatment.
Oral NSAIDs have been a mainstay of treatment. While they effectively relieve symptoms, be aware that they frequently fail to promote sustained relief. When inflammation is severe or fails to respond
to initial efforts, one may consider corticosteroid injection(s). However, keep in mind that corticosteroid injections impose the risk of aponeurosis rupture secondary to focal collagen tissue
necrosis and can result in focal heel fat pad atrophy.
Only a relatively few cases of heel pain require surgery. If required, surgery is usually for the removal of a spur, but also may involve release of the plantar fascia, removal of a bursa, or a
removal of a neuroma or other soft-tissue growth.
Flexibility is key when it comes to staving off the pain associated with these heel conditions. The body is designed to work in harmony, so stretching shouldn?t be concentrated solely on the foot
itself. The sympathetic tendons and muscles that move the foot should also be stretched and gently exercised to ensure the best results for your heel stretches. Take the time to stretch thighs,
calves and ankles to encourage healthy blood flow and relaxed muscle tension that will keep pain to a minimum. If ice is recommended by a doctor, try freezing a half bottle of water and slowly
rolling your bare foot back and forth over it for as long as is comfortable. The use of elastic or canvas straps to facilitate stretching of an extended leg can also be helpful when stretching
without an assistant handy. Once cleared by a doctor, a daily regimen of over-the-counter anti-inflammatory medication like Naproxen Sodium will keep pain at bay and increase flexibility in those
afflicted by heel pain. While this medication is not intended to act as a substitute for medical assessments, orthopedics or stretching, it can nonetheless be helpful in keeping discomfort muted
enough to enjoy daily life. When taking any medication for your heel pain, be sure to follow directions regarding food and drink, and ask your pharmacist about possible interactions with existing
medications or frequent activities.