Heel pain is experienced by millions of people all over the world. While the most common cause of heel pain is Plantar Fasciitis, there are other factors that could cause it such as nerve impingement, arthritis and tendonitis. Heel pain is frequently due to a mechanical cause but can also occur due to trauma, neurological conditions, infections, neoplastic and autoimmune conditions and systemic disorders.
A thorough and complete medical history and physical examination are critical to determining an accurate diagnosis and proper course of treatment.
Plantar Fasciitis is often associated with heel spurs that cause heel pain. A heel spur is caused by mechanical overstretching of the arch’s fibrous tissue and can develop over time or suddenly. People of all ages can suffer from a heel spur but it is experienced most commonly by individuals in their middle age and whose occupations require long periods of standing or those who are overweight or indulge in strenuous physical activities.
Plantar Fasciitis is not like other musculoskeletal injuries that heal with time and enough rest. This is due to the fact that it is almost impossible for an able person to desist from walking. When a person has an injured elbow or hand, it is possible to transfer function to another limb or to immobilize the injured hand in a sling. As such, individuals have a difficult time resting the feet sufficiently for healing to occur and the pain can recur after a given time.
Individuals with plantar fasciitis experience extreme tenderness in the heel when they attempt to walk in the morning. The human body tries to repair a structure parallel to the foot’s sole but not sufficiently enough for it to hold pressure when a person stands up. Because of the continued aggravation such as the full force of a person standing up, mending becomes difficult and inflammation can occur under the heel due to the compression.
Various methods of treatment are available but patient education is critical to obtaining compliance with the necessary regiments for treatment. The most important objective is to limit the stress on the heel, reduce inflammation, stretch and strengthen the muscles to restore improved function.
Modifying activities and avoiding high impact activities in athletes is important as well as reduction in body weight. Stretching exercises and wearing of resting or night splints, soft cushions, insoles and soft-heeled footwear are generally advised.
Recalcitrant cases can be treated with other options such as casting, corticosteroids, ESWT or extra-corporeal shock wave therapy and platelet rich plasma injections and low level laser therapy (LLLT).
Mechanical Plantar Heel Pain
Mechanical plantar heel pain is frequently presented to doctors. Plantar heel pain is insertional heel pain in the plantar fascia, with or without a heel spur. Biomechanical abnormalities that cause pathologic stress to the soft tissues are the most common culprit of plantar heel pain. Also a contributing factor is nerve entrapment of the medial calcaneal or muscular branch of the lateral plantar nerve. Some patients experience heel pain when they attempt to bear weight usually in the morning or after a period of rest. The pain could decrease after some time and recur later in the day or when a person walks or moves. Some significant findings related to plantar heel pain include high body mass index, tightness in the Achilles tendon, pain when the inferior heel is palpated and wearing of inappropriate footwear.
Individuals who suffer from plantar heel pain usually try self-remedies before seeking medical attention. It is important to see a doctor as soon as possible to avoid complications or worsening of the condition. A doctor would get information regarding the time pain usually occurs, type of shoes worn, work and leisure activities and trauma history. A physical examination would also be conducted on the lower extremity including range of motion of the ankle, palpation of the heel’s medial aspect and an evaluation of the angle and base of gait.
Identification of a plantar heel spur using an x-ray examination will indicate that the heel spur has been present for 6 or more months. As a rule of thumb, the time for final resolution of a heel spur lengthens with the duration of the condition.
Initial treatment methods would include non-steroidal anti-inflammatory medications, foot padding and strapping, and corticosteroid injections, when appropriate. Patients are also directed to avoid flat shoes and walking barefoot and to stretch the calf muscles with exercises and to limit physical exertions.
Most patients respond within 6 weeks to this initial treatment. If condition does not significantly improve, a patient should be referred to a podiatric foot and ankle surgeon for additional therapeutic actions that could involve the use of custom orthotic devices specifically designed to address biomechanical misalignments. Only when other conservative methods of treatment fail does plantar heel surgery or fasciotomy become an option.
Neurological Heel Pain
The technical term for nerve damage is peripheral neuropathy. Its symptoms include tingling, numbness, pain, burning sensations and weakness. People with nerve damage find it difficult to tell hot from cold temperatures and are at risk for injury. Causes of nerve damage could be trauma, autoimmune disorders, or other diseases.
The body’s peripheral nerve system starts with the brain and the spinal cord messages throughout the body that tell it how to respond to stimulus. For example, when one steps on something sharp, the brain sends a message to the feet telling it that the pain is from a sharp object and to remove the foot. Damaged nerves in the foot would not allow it to receive that message.
Nerve damage as a result of diabetes can also be caused by high glucose levels in the blood. Too much insulin in the body can also cause nerve damage. Diabetes can also cause blood vessels to become constricted and reduce blood flow to the feet.
Alcoholism also causes damage to the nerves in the feet due to poisoning with alcohol consumption. This is also referred to as alcoholic neuropathy.
Other disorders affecting the body’s connective tissues can also result in peripheral nerve damage. The nerves become inflamed. These disorders include tendonitis, arthritis, scleroderma and lupus.
Neurological heel pain is caused by nerve entrapment. Factors such as obesity, venous insufficiency, lesions and trauma could increase pressure on the nerves. A doctor would need to rule out systemic diseases in cases of suspected neurological heel pain.
Pain management and treatment methods will depend on the exact cause of heel pain and its underlying causes such as obesity.
Arthritic Heel Pain
Arthritis is characterized by inflammation of the cartilage and lining of the joints. It causes redness, swelling, and pain. Millions of people suffer from this condition, generally over the age of 50. This disease is a major cause of foot pain since the foot has 33 joints that can be affected.
There are various causes of arthritis but heredity plays a large role. Symptoms can present due to bacterial and viral infections, drugs, and trauma. Hammer toes, claw toes, and bunions develop due to rheumatoid arthritis and cause problems in the heel and ankle as a result of eroded joints.
Patients with arthritis are prone to plantar fasciitis especially those individuals with rheumatoid arthritis, ankylosing spondylitis, fibromyalgia and reactive arthritis.
Patients with plantar fasciitis find it difficult to walk due to associated pain. It is important to allow enough rest to heal the inflammation. Icing is a common therapy for heel pain for plantar fasciitis and the use of non-steroidal drugs like Ibuprofen.
Conservative methods of treatment of arthritic feet include appropriate footwear, orthotics and forefoot support. Shoes must provide high and wide space in the toes, wider flexibility for addition of removable insoles or insertion of orthotics that are designed for ultra comfort, support and extra cushioning. Correct footwear and orthotics will reduce pressure on the feet and result in less pain in the foot.
Achilles Heel Pain
The Achilles tendon is one of the body’s longest tendons and stretches from the bones of the heel to the calf muscles. It permits you to extend the foot and point your toes. It is also one of the most commonly injured tendons and could become swollen and painful. In severe cases of injury, excessive force can cause it to tear or completely rupture.
Injuries to the Achilles tendon can occur due to overuse, sudden increase in physical activity, insufficient stretching before exercise, high heeled shoes that cause stress on the tendon, flat feet condition or over-pronation and tightness in the muscles or tendons in the leg.
Athletes who are into running, dance, football, gymnastics, baseball, basketball, tennis and other extreme sports are prone to Achilles tendon injuries.
Typical symptoms of an Achilles tendon injury include pain at the back of the foot and above the heel particularly when stretching the ankle or standing on your toes, tenderness and swelling, stiffness, difficulties in flexing the foot or pointing the toes.
A thorough physical examination needs to be made by a qualified health practitioner to diagnose this type of injury. Fortunately, mild cases of injuries heal over time. Apart from rest, a doctor would recommend icing for reducing the pain and swelling, leg compression and elevation, stretching exercises and non-steroidal anti-inflammatory drugs. Heel lifts would also be recommended to be worn as shoe inserts during recovery to protect the Achilles tendon from stretching further.
Foot Orthotics for Heel Pain Relief
The American Orthopedic Foot and Ankle Society recommends shoe inserts, medications and stretching as the first line of defense against heel pain.
Orthotic devices are frequently used to treat heel pain, heel spurs and plantar fasciitis. They work best when used within a comprehensive treatment plan for addressing the underlying cause of the problem and not just to mask the symptoms. Orthotic devices are designed to treat sub-par foot mechanics and provide arch support. Orthotics relieve excess pressure on the plantar fascia so that healing can occur.
Research findings state that almost 95% of women who used shoe inserts and performed stretching exercises for the Achilles tendon and the plantar fascia improved after 8 weeks. In case conservative treatment methods fail, patients may be required to wear prescription heel orthotics and undergo physical therapy. Surgery is also the last option for severe cases of heel pain that do not respond to other forms of treatment.
Thousands of people suffering from heel pain due to heel spurs and plantar fasciitis have found relief in foot orthotics. Plantar fasciitis is a common foot disorder but it is preventable. The best way to avoid foot problems is to wear well-fitted shoes with a firm sole and soft upper. Shoes should be purchased in the afternoon or after walking so that the feet would have swelled.
Many women experience heel pain due to high heeled shoes. Many fashionable shoes are designed in such a way that they constrict the feet. Ensure that you choose shoes with a wide toe room with reinforced heels and cushioned insoles.
Insoles are flat inserts placed inside the shoe for extra cushioning. They reduce shock and provide support for the heel and the arches. People have different reactions to insoles and what could be effective for a person may work differently for another. There are many types of insoles in the market made of various materials like leather, plastic foam, rubber or cork. Effective insoles are those made with visco-elastic polymers that are gel-like. Your podiatrist can recommend the best insoles for you as well as other orthotic devices to correct mechanical problems that cause foot pain.
Individuals with short, tightened Achilles’ tendons would benefit from wearing heel cushions. They are similar to insoles as they are inserted inside the shoes.
For severe cases such as fallen arches or structural problems resulting in imbalance, podiatrists may recommend prescription orthotics or orthoses which are molded from a patient’s foot. There are generally three categories of foot orthotics: rigid, soft or semi-rigid.
Custom or Over-the Counter Orthotics?
Orthotics are foot devices designed to alter or modify foot function for the treatment and support of assorted biomechanical foot disorders. There are commercially made devices like cushioned shoe insoles or heel cups sold over the counter in retail stores.
Although over-the-counter foot orthotics can be bought easily, the downside is that people who try to solve their foot problems without properly figuring out the cause of the problem and just buy shoe inserts to eliminate the symptoms can make the condition worse. It is important to get the right type of orthotics recommended by a qualified health practitioner such as podiatrists. Symptoms of heel pain is the end result of a problem or weakness that needs proper diagnosis and treatment.
The most effective type of orthotics are custom made that are prescribed specifically for the needs of an individual patient. These custom devices are made with a cast of the patient’s foot that replicates misalignments in the foot structure. With computer technology, orthotic lab technicians create a device designed to balance out these misalignments.
Podiatrists recommend the best orthopedic devices for their patients for the treatment of various conditions of heel pain such as plantar fasciitis, heel spurs, arthritic heel pain and Achilles’ heel pain. The finished device is placed inside the patient’s shoe for foot support and to eliminate abnormal foot biomechanics by ensuring that the foot is aligned correctly. Based on a patient’s needs, orthotics can have paddings to cushion the foot for added comfort.
Custom orthotics are more expensive than over the counter orthotics that are manufactured with the “fit-for-all” concept. Unlike commercially available devices, custom orthotics are unique to the patient’s specific foot condition and address individual problems.
In the treatment of various causes of heel pain, custom foot orthotics enhance other conservative methods of treatment to optimize foot function and enable individuals to regain quality of life.