Every time you take a step, one of your heels has to support the whole weight of your body. As you move, the load is equal to 20 times your own body weight. The load is softened by a pillow of fat
under the heel and a large sinew or ligament (the fibrous tissue that joins muscle and bone together) under the sole of the foot. This sinew is called the plantar fascia and it pulls the heel bone
forward (in opposition to the Achilles tendon, which pulls it backwards). If an athlete does not warm up properly or a person with a sedentary job exercises heavily during the weekends, they might
overload the muscles of the calf or strain the Achilles tendon, which joins these muscles to the heel bone. When overloaded the tendon becomes tight and painfully inflamed, which places extra strain
on the plantar fascia and muscles in the soles of the foot. The strained plantar fascia becomes inflamed and may even develop tiny cracks. This is known as plantar fasciitis. Every time you sit down,
sleep or otherwise rest your legs, the muscles of the sole of the foot will contract in an attempt to protect the damaged sinew. The pain in the heel will then no longer be felt. But when you get up
again and put weight on the foot, the foot and ankle may feel stiff (because of the inflammation) and the pain will return either at the back of the heel or on the soles of the feet. When you start
to move, the plantar fascia may crack even more causing a vicious cycle of damage and Heel Pain
. Inflammation at the point where the Achilles tendon (at
the back of the heel) or the plantar fascia (under the heel) join the heel bone (a bone known as the Calcaneum) stimulates cells that form bone to deposit bone in this area, eventually leading to the
build up of a bony prominence on the heel bone called a calcaneal spur. But it's not the spur itself that causes the pain. The spur is a sign of chronic inflammation in the connective tissues, which
is the result of a prolonged overload. It should also be pointed out that heel spurs can occur on their own, without plantar fasciitis or pain, or may be linked to some types of arthritis
(inflammation of the joints). And plantar fasciitis or Achilles tendonitis don't necessarily lead to spur formation.
some heel pain can be caused by rheumatological diseases, and these pains can do a real good impersonation of plantar fasciitis symptoms. Seronegative Arthropathies such as Psoriatic Arthritis,
Reactive Arthritis and Ankylosing Spondylisis are the most common types to cause heel pain by producing an inflammatory reaction where the fascia attaches to the heel. This is called an enthesitis.
If you have a history of Psoriasis or a family history of other arthritic conditions listed above we recommend you see a clinician about your heel pain to confirm the diagnosis. Another occasional
cause of heel pain is loss of the cushioning fat pad of the heel, which can result in a bruised heel bone (calcaneus). If you can easily feel your heel bone through your skin on the bottom of your
foot you may well have poor fatty tissue on your heel. Pressing on the centre of your heel should feel like pushing into firm rubber, and your skin should not move easily. If you can pinch the skin
under your heel and feel a very hard lump when you press the bottom of your heel then it is likely you have a heel fat pad problem. One simple final test is to walk on a hard floor. If you feel the
pain only when your heel hits the ground a fat pad problem is most likely. If the pain mainly occurs as you lift the heel off the ground it is more likely to be plantar fasciitis.
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.
Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your
doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray will show any arthritis in the
ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a scan may be
used to help spot arthritis or a stress fracture.
Non Surgical Treatment
The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone. Early treatment might involve oral or injectable anti-inflammatory medication,
exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically
restful state. Physical therapy may be used in conjunction with such treatments. A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive
pronation, and supporting the ligaments and tendons attaching to the heel bone. 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 more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or
other soft-tissue growth.
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
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.