Heel Pain

Of the 26 bones located on your foot, your heel bone is the biggest one. It also has a network of more than 100 ligaments, tendons, and muscles on top of 33 joints. Like many other bones, it's subject to stimuli from the outside that can affect its ability to keep you on your feet as well as its overall integrity. Heel pain can sometimes disable you and can happen at the bottom, back, or front of your heel.

Common Heel Pain Causes
There are many causes of heel pain, although the most common one is faulty biomechanics or abnormalities from your walking gait that place too much pressure or stress on your soft tissues attached to your heel bone and the heel itself. This stress can also happen thanks to injury or a bruise you've gotten by jumping, running, or walking on hard surfaces. If you're overweight or you're wearing flimsy flip-flops, that could also lead to heel pain.

Heel Spur
If your heel bone's underside has a bony growth, then that's a heel spur. It's typically visible via x-ray and looks like a bulge that could stretch forward as much as 1/2 of an inch. This is typically called "heel spur syndrome" during those instances where there's no visible bone enlargement but the pain is still there.

This complication is caused by strain on the ligaments and muscles of your foot, particularly when the long band of the tissue that links the ball and heel of the foot together is stretched to its utmost. The membrane or lining that covers the heel bone can also be repeatedly torn away, resulting in a spur. It can result from obesity, wearing excessively worn or improperly fitted shoes, running or jogging, and biomechanical imbalance.

Plantar Fasciitis
As for plantar fasciitis, both heel spurs and heel pain are commonly linked with this particular disease, which is the inflammation of the fascia (band of fibrous connective tissue) that runs along the plantar surface (bottom of the foot), from the ball of the foot to the heel. Athletes typically suffer from this malady, especially when they jump or run a lot (i.e., basketball players, marathon runners, and so forth).

This disease happens whenever the bottom of your foot is stressed over time beyond its normal extending capabilities, which causes soft tissue fascia fibers to stretch or tear at points along its length. This then leads to symptoms such as bone spur growth, pain, and inflammation where the heel bone and the plantar fascia are attached to each other. Lack of support and tight shoes might aggravate the inflammation, particularly the foot's arched area.

Chronic irritation can sometimes accompany an athletic lifestyle when suffering from plantar fasciitis. You can get relief by resting, but that's only temporary comfort. Once you go about walking again, after sleeping for the night, you will experience sudden fascia band elongation, which pulls and stretches on the heel. While walking, the heel pain might disappear or at least decrease, but that only provides a false sense of relief. The pain will return after extensive walking or even prolonged rest.

Excessive Pronation
Too much pronation (the flexible flattening motion of the arch of the foot that enables you to adapt to whatever ground surfaces you're standing on for the sake of shock absorption in your walk cycle) can result in heel pain. Too much of anything is bad, after all. While walking, it's the heel that has ground contact first. The weight then shifts to the outside of your foot, until it reaches to your big toe.

Afterwards, the arch comes up and the foot is rolled upwards and outwards, becoming stable and rigid in order to lift your body to ensure locomotion. Pronation or inward motion that's excessive can hurt your heel because there's incredible pulling and stretching caused by this abnormal movement on your foot's tendons and ligaments that are attached to the heel bone's bottom back. This excess in pronation might also result in lower back, knee, and hip injury.

Achilles Tendinitis
The back of your heel might also result in pain there, which might be caused by Achilles tendinitis, otherwise known as Achilles tendon inflammation as it goes behind your ankle and inserts itself on the heel bone's back surface. It's usually seen in people who walk and run excessively while having tight tendons.

Once your tendon is strained after a while, its fibers will stretch and tear along its length or a heel bone insertion might occur. If you have Achilles tendinitis, you tend to suffer from possible bone spur growth at the heel bone's back, extreme pain, and inflammation of the area. Inflammation aggravation can also occur if you're an athlete with an active lifestyle that puts too much strain on your already tight tendons.

Other Heel Pain Causes
Heel pain can also be caused by the following issues:

  • Rheumatoid Arthritis: This and many other arthritis forms—such as gout—can manifest themselves in your big toe joint and affect your heel's well-being.
  • Soft-Tissue Outgrowths: If your bursa (a small sac of fluid that's irritated) is inflamed (bursitis), if you have a neuroma (a nerve growth), or if you're suffering from any other soft-tissue outgrowth, you might suffer from heel pain or even a heel spur complication.
  • Haglund's Deformity or Pump Bump: This bone enlargement or deformity behind your heel bone, particularly the area where your Achilles tendon is attached to your that bone, can make you writhe in heel pain. It's usually generated by bursitis caused by shoe pressure, and it can be worsened by the stitching or height of a heel counter of any given shoe.
  • A Bone Bruise or Contusion: If the tissues covering your heel bone begin to get inflamed, then you might be suffering from a bone contusion or bruise. It's not the bone itself that's bruised, but this is still a painfully sharp injury that can develop thanks to direct impact of a hard surface or blunt object on your foot.

When to Go to a Podiatrist
You should go to a doctor with podiatric medical expertise if your heel pain starts to limit your normal daily activities, persist in pain, and can cause continual heat, swelling, and redness (inflammation).

Diagnosing and Treating Heel Pain
As for heel pain diagnosis and treatment, your podiatrist will first check out the affected area and may even request an x-ray scan of it to rule out heel spur or broken bone issues. Initial treatment may include injectable or oral anti-inflammation medication, an exercise regimen, and shoe—or shoe insert as well as taping or strapping—recommendations to keep your feet pressure-free.

Orthotics devices are typically called for, although strapping and taping can give much-needed foot support while placing your aching tendons and muscles in a more comfortable, restful position. Physical therapy might also be used together with other treatments to ensure their effectiveness.

Because biomechanical imbalance is the most common issue when it comes to heel pain, orthotics devices can be used for correcting that problem, specifically when it comes to ligament and tendon (the ones attached to the heel bone) support as well as pronation control. The majority of arch and heel pains can be treated by such tools without requiring surgery.

Sometimes, surgery or more advanced treatments are called for when it comes to dealing with heel pain. If surgery is required, you might have to undergo plantar fascia release, spur removal, bursa removal, or neuroma removal (essentially, removal of any soft-tissue outgrowths).

Preventing Heel Pain
A multitude of steps can be undertaken to prevent heel pain formation and its many complications:

  • Wear form-fitting shoes—not too tight, not too loose, and fits well on the sides, front, and back—that have supportive heel counters, rigid shanks, and shock-absorbing soles.
  • Every activity necessitates different shoes, so wear the proper ones depending on what you're doing.
  • Avoid wearing shoes with high heels or excessively worn soles.
  • Before exercising, warm up. Do stretching exercises and whatnot before and after running.
  • When participating in athletic activities, never forget to pace yourself.
  • Rest and good nutrition is your best bet in avoiding heel pain.
  • If you're obese or overweight, lose some or all of those excess pounds.

Dr. Arshia Roohian is currently serving cities including Laguna Woods, Irvine, Rancho Santa Margarita, Mission Viejo, Laguna Hills, and Lake Forest. She offers expert and professional podiatric services including heel pain treatment. She performs different heel pain procedures and surgeries on a daily basis, so you can make appointment online and in real-time.