Heel Pain Has Many Causes
In our pursuit of
healthy bodies, pain can be an enemy. In some instances, however,
it is of biological benefit. Pain that occurs right after an
injury or early in an illness may play a protective role, often
warning us about the damage we've suffered.
When we sprain
an ankle, for example, the pain warns us that the ligament and
soft tissues may be frayed and bruised, and that further activity
may cause additional injury.
Pain, such as
may occur in our heels, also alerts us to seek medical attention.
This alert is of utmost importance because of the many afflictions
that contribute to heel pain.
Heel pain is generally
the result of faulty biomechanics (walking gait abnormalities)
which place too much stress on the heel bone and the soft tissues
that attach to it. The stress may also result from injury, or
a bruise incurred while walking, running, or jumping on hard
surfaces; wearing poorly constructed footwear- thus comfortable footwear is of utmost importance; or being overweight.
The heel bone
is the largest of 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, sometimes disabling, can occur in the front,
back, or bottom of the heel.
A common cause of
heel pain is the heel spur, a bony growth on the underside, forepart
of the heel bone. The spur, visible by X-ray, appears as a protrusion
that can extend forward as much as half an inch. When there is
no indication of bone enlargement, the condition is sometimes
referred to as "heel spur syndrome."
Heel spurs result
from strain on the muscles of the foot, by stretching of the
long band of tissue that connects the heel and the ball of the
foot, and by repeated tearing away of the lining or membrane
that covers the heel bone. These conditions may result from biomechanical
imbalance, running or jogging, improperly fitted or excessively
worn shoes, or obesity.
Both heel pain and
heel spurs are frequently associated with an inflammation of
the band of fibrous connective tissue (fascia) running along
the bottom (plantar surface) of the foot, from the heel to the
ball of the foot. The inflammation is called plantar fasciitis.
It is common among athletes who run and jump a lot, and can be
occurs when the plantar fascia flattens out and elongates over
time beyond its normal extension, causing the soft tissue fibers
of the fascia to tear or stretch at various points along its
length, including at the heel bone A gap occurs, which between
the fascia and the heel bone may be filled in with the growth
of new bone.
may be aggravated by shoes that lack appropriate support, especially
in the arch area, and by the chronic irritation that sometimes
accompanies an athletic lifestyle.
only temporary relief. When you resume walking, particularly
after a night's sleep, you may experience a sudden elongation
of the fascia band which stretches and pulls on the heel. As
you walk, the heel pain may lessen or even disappear, but that
may be just a false sense of relief. The pain often returns after
Heel pain sometimes
results from excessive pronation. Pronation is the normal flexible
motion of the foot that allows it to adapt to ground surfaces
and absorb shock in the normal walking pattern.
As you walk, the
heel contacts the ground first; the weight shifts first to the
outside of the foot, then moves toward the big toe. The arch
rises, the foot generally rolls upward and outward, becoming
rigid and stable in order to lift the body and move it forward.
Excessive pronation -- excessive inward motion -- can create
an abnormal amount of stretching and pulling on the fascia while
jogging or running, for example. Excessive pronation may also
contribute to injury to the hip, knee, and lower back.
Disease and Heel Pain
Some general health
conditions can also bring about heel pain.
and other forms of arthritis, including gout, which usually manifests
itself in the big toe joint, can cause heel discomfort in some
Heel pain may
also be the result of an inflamed bursa (bursitis), a small,
irritated sack of fluid; a neuroma (a nerve growth); or another
soft-tissue growth. Such heel pain may be associated with a heel
spur, or may mimic the pain of a heel spur.
("pump bump") is a bone enlargement at the back of
the heel bone, in the area where the Achilles tendon attaches
to the bone. This sometimes painful deformity generally is the
result of bursitis caused by pressure against the shoe, and can
be aggravated by the height or stitching of a heel counter of
a particular shoe.
and stone bruises, are common heel injuries. A bone bruise or
contusion is an inflammation of the skin that covers the heel
bone. A stone bruise is a sharply painful injury caused by the
direct impact of a hard object or surface on the foot.
can occur, but these are less frequent.
Children's Heel Pain
Heel pain can also
occur in children, most commonly between ages 8 and 13, as they
become increasingly active in sports activity in and out of school.
This physical activity, particularly jumping, irritates the growth
centers of the heels; the more active the child, the more likely
the condition will occur. When the bones mature, the problems
disappear and are not likely to recur. If pain is disabling,
professional care may be indicated to provide relief. Other good
news is that heel spurs do not often develop in children.
A variety of steps can be taken to avoid heel
pain and accompanying afflictions:
- Wear shoes that fit well -- front,
back, and sides -- and have shock-absorbent soles, rigid shanks,
and supportive heel counters.
- Wear the proper shoes for each activity.
- Do not wear shoes with excessive
wear on heels or soles.
- Prepare properly before exercising.
Warm up before running or walking, and do some stretching exercises
- Pace yourself when you participate
in athletic activities.
- Don't underestimate your body's need
for rest and good nutrition.
- If obese, lose weight.
Podiatric Medical Care
If pain and other
symptoms of inflammation -- redness, swelling, heat -- persist,
you should limit normal daily activities and contact a doctor
of podiatric medicine.
may perform various diagnostic X-rays, to rule out heel spurs
might involve oral or injectable anti-inflammatory medication,
exercise and shoe recommendations, taping or strapping, or use
of various shoe inserts -- orthotic devices. Taping or strapping
supports the foot, placing stressed muscles in a physiologically
restful state and preventing stretching of the plantar fascia.
Physical therapy may be used in conjunction with such treatments.
A functional orthotic
device may be prescribed for correcting biomechanical imbalance,
supporting the heel, controlling excessive pronation and stretching
of the plantar fascia. It will effectively treat the majority
of heel and arch pain without the need for surgery.
Only a relatively
few cases of heel pain require surgery. If surgery is necessary,
it is usually for the removal of a spur, but also may involve
release of the plantar fascia, removal of a bursa, or removal
of a neuroma or other soft-tissue growth.