Does Your Foot Hurt Here?: The Heel
July 1, 2021
Pain in the heel is incredibly common and a vast majority will typically fall into a few different categories. These pains will most likely develop over time, however few will present seemingly out of the blue. There are several nonsurgical ways to treat these problems to better the pain. In fact, it is less common to need surgery in the first place. Let’s get into a few of the most common and treatable types of heel pain.
Achilles Tendon
The Achilles tendon is the longest and strongest tendon in your body. Given its strength, the tendon endures a lot of force. Traditionally over several months and years, there can be scar tissue that builds up with wear and tear that occurs to the tendon. Sometimes even bone spurs will form insidiously along the back of the heel imbedded in the tendon.
Symptoms: The body’s reaction to these processes results in more scar tissue and even more bone spurs. Those changes can be painful and it is possible to notice thickening pressure in the back of your shoe, focal prominence, and pain with walking and motion in the heel. Located directly in the back of the heel, the pain does not typically radiate on the bottom; however, pain may be present on the sides.
Treatment: In the beginning, a common solution is to get a heel cup or lift to take the tension off the heel (think high heeled shoe!) This will relax the tendon and allow it to heal and calm down. There are also many topical anti-inflammatories that are found over the counter that are often recommended. Once the treatment starts relieving swelling and feeling better, its best to start some light stretching. This focuses on the calf and hamstrings. If the pain is not feeling any better after a few weeks, then it may be necessary to get an x-ray and evaluation with Dr. Miller. There are several options depending on the severity and activity level that are likely beneficial.
Plantar Fasciitis
Plantar Fasciitis is pain attributed to the bottom of your heel and is one of the most common things that an orthopedic surgeon will see. Plantar fascia is a cord of tissue from the bottom of your heel that goes to your toes. It is made up of collagen tissue and helps support the arch of the foot. Think of this structure as the bowstring to the arch of the foot. Although there are several theories as to why this occurs (including tightness and contracture in the legs), there still isn’t a great understanding of what causes plantar fascia and is often treated in many different methods.
Symptoms: Often times, people will experience this pain when first getting up from sitting or first thing in the morning. This pain is located directly at the bottom of the heel pad closer to the arch and may be manageable during different parts of the day. Typically, the pain tends to improve as the day goes on, but not always. Severe cases can last constantly.
Treatment: Patients suffering from plantar fasciitis are urged to try several modalities at once because the remedy might be different from one patient to another. The first area to target is flexibility, a key to recover from this problem. Try to focus on the calf stretching initially. The more flexible the ankle is, the less stress there is on the soft tissue. In this case, a heel cup or full-length shoe insert is a good idea because it will redistribute the weight the heel is bearing so the force can be spread throughout the foot and the arch. Another remedy to relieve the pain is a night splint that will target the flexibility while the body is sleeping. This will further help the morning pain in the heel. If these modalities are not helping in recovery, then it is appropriate to get an evaluation with Dr. Miller and make sure it is actually plantar fasciitis. Other options for recovery include an injection or other non-surgical treatments such as shockwave therapy or biological type treatments such as platelet injections. These should be discussed as needed at your evaluation.
Stress Fracture
A common type of bone injury to the foot or heel is a stress fracture. Repetitive activity is often associated with this type of injury. Often young kids play sports all weekend long and end up with unremitting pain and difficulty walking. People who stand on their feet several hours can suffer bone injury. Runners classically suffer from this type of problem. Stress fractures can be caused from many different activities or more aggressive force on the heel. True fractures of the calcaneus are usually from a fall from the height of 4-5 feet or more. Those accidents may be traumatic with lots of swelling and bruising along with it.
Symptoms: Stress and bone pain in the heel is a generalized pain all around the heel. It is often not just on one side of the bone. It comes with continuous pain and does not resolve as well as the day goes on.
Treatment: Any traumatic fall from a significant height should be evaluated immediately. At that point, the foot should be non-weight-bearing prior to x-ray evaluation. If there was no associated trauma, boot therapy is often enough to begin treatment. Timing and duration are usually best assessed in the office with Dr. Miller.
Are You Suffering From Heel Pain?
Dr. Miller is available at several locations around the Cincinnati area with Beacon Orthopaedics to assess your lower extremity. Contact us today for more information! Click here to learn more and schedule an appointment with Dr. Miller for your foot and ankle problem.