Foot pain/ Heel pain

An Overview

Heel pain is a common foot condition. It’s usually felt as an intense pain when using the affected heel.
Heel pain usually builds up gradually and gets worse over time. The pain is often severe and occurs when you place weight on your heel. In most cases, only one heel is affected, although estimates suggest that around a third of people have pain in both heels.

The pain is usually worse first thing in the morning, or when you first take a step after a period of inactivity. Walking usually improves the pain, but it often gets worse again after walking or standing for a long time. Some people may limp or develop an abnormal walking style as they try to avoid placing weight on the affected heel.

The pain can be throbbing and simply annoying, stabbing and debilitating, or something in between depending on what’s behind it and the severity of your case. Your heel bone—called the calcaneus—lies at the back of the foot beneath the ankle. Along with surrounding tissues and another small bone called the talus, your heel bone works to provide balance and side-to-side movement of the back of the foot.

Symptoms of heel pain

Heel pain symptoms vary depending on the cause. In addition to pain, you may experience:
• Bony growth on the heel.
• Discoloration (bruising or redness).
• Stiffness.
• Swelling.
• Tenderness.
• Pain after standing from a resting/sitting position.

Causes of heel pain

Most cases of heel pain are caused when a band of tissue in the foot, known as the plantar fascia, becomes damaged and thickens. Plantar fasciitis is the medical term for the thickening of the plantar fascia.
While deciding which applies to you is best left to your doctor, knowing more about the causes can help you prepare for that conversation.

The two most common causes of heel pain are plantar fasciitis and Achilles tendonitis

The plantar fascia

The plantar fascia is a tough and flexible band of tissue that runs under the sole of the foot. It connects the heel bone with the bones of the foot, and acts as a kind of shock absorber to the foot.

Achilles Tendonitis

Achilles tendonitis refers to inflammation of the Achilles tendon—a large, cord-like tendon that attaches to the back of your heel bone. The tightening or burning pain of Achilles tendonitis is located at the part of the tendon that is slightly above the heel bone. Mild swelling around the tendon and morning stiffness in the heel and calf are also often experienced.

Stress Fractures

Stress fractures of the foot and heel commonly occur in athletes or long distance runners who increase their running mileage over a short period of time. Repeated stress on the heel bone eventually leads to a break

Heel Pad Bruise

A heel pad bruise causes a sharp pain over the bottom of the heel.7 It may occur after trauma (e.g., landing from a high fall or stepping on a stone) or excessive weight-bearing exercises (e.g., running long distances in poorly cushioned shoes).

Fat Pad Atrophy

In older adults, the cushioning fat of your heel pad may atrophy or break down. Unlike plantar fasciitis, the pain of fat pad atrophy is absent in the morning but worsens with activity during the day.

Diagnosis

Most heel conditions can be diagnosed with a medical history and physical examination alone. In certain cases, though, additional tests like imaging studies and/or blood tests are warranted.

Physical Examination

During your physical exam, your doctor will inspect and press on (palpate) various areas of your foot, including your heel, as well as your ankle, calf, and lower leg. By doing this, they can check for areas of focal tenderness, swelling, bruising, rash, or deformity.

Bloodwork

While blood tests are not commonly ordered for the diagnosis of heel pain, your doctor may order one or more laboratory studies if they suspect or want to rule out a particular condition.

Nerve Pain

Irritation of a nerve in the lower back (called radiculopathy) may cause pain of the calf muscle that moves down the leg into the heel. In addition, peripheral neuropathies associated with diabetes, alcohol abuse, or a vitamin deficiency can cause diffuse foot and heel pain.

Treatment

Treatment depends entirely on the root cause of your heel pain. If you are unsure of your diagnosis, or how severe your condition is, be sure to seek medical advice before beginning any treatment plan.
Some common treatments are listed below—but keep in mind, not all of these are appropriate for every condition.

Rest

For more acute causes of heel pain, such as a heel bruise, avoiding the precipitating activity may be all you need to feel better. For example, take a few days off jogging or prolonged standing/walking.

Icing

For most sources of heel pain, applying an ice pack over the heel for 20-minute intervals up to four times daily can help diminish swelling and soothe your pain.

Taping

Taping the foot with sports tape or hypoallergenic tape is useful for certain heel diagnoses like plantar fasciitis, heel pad bruise, and heel pad syndrome

Exercise/Physical Therapy

Exercises and stretches are designed to relax the tissues that surround the heel bone. Some simple exercises, performed in the morning and evening, often help patients feel better quickly.

Medications

Nonsteroidal anti-inflammatory medications (NSAIDs) are commonly prescribed for heel pain caused by problems such as plantar fasciitis,23Achilles tendonitis, a heel pad bruise, Haglund’s syndrome, heel bursitis, heel pad syndrome, and sinus tarsi syndrome.
For more severe heel pain, like that caused by a heel fracture, opioidsmay be prescribed for a short period of time.

Surgery

For most causes of heel pain, surgery is generally only recommended if nonsurgical therapies have not worked for a period of six to 12 months.

Prevention

• Gradually increasing activity levels: Increasing your athletic activities gradually over time and taking breaks can help prevent heel injury.
• Maintaining ideal body weight: Excess body weight places increased stress on the lower extremities, including the heel.
• Wearing the right footwear: Wearing appropriate, properly fitting footwear—shoes with adequate support and cushioning—is critical for the prevention of many types of heel pain.

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