Your foot is made up of 26 bones, 33 joints, and more than 100 tendons. The heel is the largest bone in your foot. If you overuse or injure your heel, you may experience Heel Pain
. This can range from mild to disabling. In many cases, if you have heel pain, you will need a doctor to diagnose the
The most common local causes of heel pain include. Plantar fasciitis, plantar fasciitis is a painful inflammation of the plantar fascia, a fibrous band of tissue on the sole of the foot that helps to
support the arch. Plantar fasciitis occurs when the plantar fascia is overloaded or overstretched. This causes small tears in the fibers of the fascia, especially where the fascia meets the heel
bone. Plantar fasciitis may develop in just about anyone but it is particularly common in the following groups of people: people with diabetes, obese people, pregnant women, runners, volleyball
players, tennis players and people who participate in step aerobics or stair climbing. You also can trigger plantar fasciitis by pushing a large appliance or piece of furniture or by wearing worn out
or poorly constructed shoes. In athletes, plantar fasciitis may follow a period of intense training, especially in runners who push themselves to run longer distances. People with flat feet have a
higher risk of developing plantar fasciitis. Heel spur, a heel spur is an abnormal growth of bone at the area where the plantar fascia attaches to the heel bone. It is caused by long-term strain on
the plantar fascia and muscles of the foot, especially in obese people, runners or joggers. As in plantar fasciitis, shoes that are worn out, poorly fitting or poorly constructed can aggravate the
problem. Heel spurs may not be the cause of heel pain even when seen on an X-ray. In fact, they may develop as a reaction to plantar fasciitis. Calcaneal apophysitis, in this condition, the center of
the heel bone becomes irritated as a result of a new shoe or increased athletic activity. This pain occurs in the back of the heel, not the bottom. Calcaneal apophysitis is a fairly common cause of
heel pain in active, growing children between the ages of 8 and 14. Although almost any boy or girl can be affected, children who participate in sports that require a lot of jumping have the highest
risk of developing this condition. Bursitis means inflammation of a bursa, a sac that lines many joints and allows tendons and muscles to move easily when the joint is moving. In the heel, bursitis
may cause pain at the underside or back of the heel. In some cases, heel bursitis is related to structural problems of the foot that cause an abnormal gait (way of walking). In other cases, wearing
shoes with poorly cushioned heels can trigger bursitis. Pump bump, this condition, medically known as posterior calcaneal exostosis, is an abnormal bony growth at the back of the heel. It is
especially common in young women, in whom it is often related to long-term bursitis caused by pressure from pump shoes. Like other parts of the foot, the heel can be bumped and bruised accidentally.
Typically, this happens as a "stone bruise," an impact injury caused by stepping on a sharp object while walking barefoot. In most cases, Achilles tendonitis (inflammation of the Achilles tendon) is
triggered by overuse, especially by excessive jumping during sports. However, it also can be related to poorly fitting shoes if the upper back portion of a shoe digs into the Achilles tendon at the
back of the heel. Less often, it is caused by an inflammatory illness, such as ankylosing spondylitis (also called axial spondylarthritis), reactive arthritis, gout or rheumatoid arthritis.
Compression of a small nerve (a branch of the lateral plantar nerve) can cause pain, numbness or tingling in the heel area. In many cases, this nerve compression is related to a sprain, fracture or
varicose (swollen) vein near the heel.
Symptoms of plantar fasciitis vary, but the classic symptom is pain after rest--when you first get out of bed in the morning, or when you get up after sitting down for a while during the day. The
pain usually diminishes after a few minutes of walking, sometimes even disappearing, but the pain is commonly felt again the longer you're on the foot. Fasciitis can be aggravated by shoes that lack
appropriate support, especially in the arch area, and by the chronic irritation of long-periods of standing, especially on concrete, by being overweight. It doesn't help that fascia doesn't heal
particularly quickly because it has relatively poor circulation (which is why it's white in colour).
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
Treatment options for plantar fasciitis include custom prescription foot orthoses (orthotics), weight loss when indicated, steroid injections and physical therapy to decrease the inflammation,
night-splints and/or cast boots to splint and limit the stress on the plantar fascia. Orthotripsy (high frequency ultra-sonic shock waves) is also a new treatment option that has been shown to
decrease the pain significantly in 50 to 85 percent of patients in published studies. Surgery, which can be done endoscopically, is usually not needed for over 90 percent of the cases of plantar
fasciitis. (However, when surgery is needed, it is about 85 percent successful.) Patients who are overweight do not seem to benefit as much from surgery. Generally, plantar fasciitis is a condition
people learn to control. There are a few conditions similar to plantar fascia in which patients should be aware. The most common is a rupture of the plantar fascia: the patient continues to exercise
despite the symptoms and experiences a sudden sharp pain on the bottom of the heel and cannot stand on his or her toes, resulting in bruising in the arch. Ruptures are treated very successfully by
immobilization in a cast boot for two to six weeks, a period of active rest and physical therapy. Another problem with prolonged and neglected plantar fasciitis is development of a stress fracture
from the constant traction of this ligament on the heel bone. This appears more common in osteoporotic women, and is also treated with cast boot immobilization. The nerves that run along the heel
occasionally become inflamed by the subsequent thickening and inflammation of the adjacent plantar fascia. These symptoms often feel like numbness and burning and usually resolve with physical
therapy and injections. Patients should also be aware that heel numbness can be the first sign of a back problem.
It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your
heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would
also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the
inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an
operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after
Prevention of heel pain involves reducing the stress on that part of the body. Tips include. Barefeet, when on hard ground make sure you are wearing shoes. Bodyweight, if you are overweight there is
more stress on the heels when you walk or run. Try to lose weight. Footwear, footwear that has material which can absorb some of the stress placed on the heel may help protect it. Examples include
heel pads. Make sure your shoes fit properly and do not have worn down heels or soles. If you notice a link between a particular pair of shoes and heel pain, stop wearing them. Rest, if you are
especially susceptible to heel pain, try to spend more time resting and less time on your feet. It is best to discuss this point with a specialized health care professional. Sports, warm up properly
before engaging in activities that may place lots of stress on the heels. Make sure you have proper sports shoes for your task.