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Heel Pain

What is heel pain?

 

The most common cause of heel pain is plantar fasciitis - inflammation of your plantar fascia (a ligament in the foot). Other causes of heel pain can be from nerve entrapment, bone marrow edema (bone bruise), calcaneal apophysitis, haglund’s deformity, Achilles tendinitis, or stress fracture.

 

What causes heel pain/plantar fasciitis?

 

Plantar fasciitis is the inflammation of the plantar fascia. This can be due to overuse - either an accumulation of microtrauma over time or recent increase in activities or weight.

 

What are the common symptoms?

 

Plantar fasciitis presents as pain in the heel or the arch. It is frequently accompanied by post-static dyskinesia - pain when trying to walk after a period of rest. The pain can affect your quality of life and limit daily activities.

 

A heel spur may be detected with an X-ray. It is important to note that the heel spur itself does not cause the pain. Rather, it serves as an indicator that the condition itself is chronic.

 

What are my options?

 

Oftentimes, if you decrease your activities, ice the area, and try over-the-counter anti-inflammatory drugs, the symptoms can resolve itself. If symptoms failed to resolve within two weeks, it is highly recommended that you see a podiatrist for treatments so you can bounce back faster. With advances in technology, treatments for plantar fasciitis can be pain free. Also keep in mind that the sooner you are evaluated, the easier and faster it is for you to return to normal daily activities.

 

Depending on your presentation upon evaluation, some of the treatment options include but are not limited to:

 

  • Steroid injection

  • Connective tissue injection

  • Custom inserts

  • Dorsal splint

  • Prescription medication

  • Physical therapy

Other causes of heel pain

Other Causes of Heel Pain

Achilles Tendinitis

Nerve Entrapment

Bone Marrow Edema (Bone Bruise)

Calcaneal Apophysitis - Growth Pain

Haglund’s Deformity

Stress Reaction

Achilles Tendinitis

 

What is Achilles tendinitis?

 

Achille tendinitis is the inflammation of the Achilles tendon - a tough band of fibrous tissue that connects your calf muscle to your heel. It is the largest tendon in your body. If left untreated, it can turn into tendinopathy and eventually develops microtears that can make it more prone to a rupture.

 

What causes Achilles tendinitis?

 

Achilles tendinitis can develop from overuse (e.g. jobs require walking up and down stairs all day), recent increase in activities (e.g. basketball, running), or weight gain. There is an underlying biomechanical cause in the majority of the time.

 

How does it present?

 

Achille tendinitis presents as pain in the back of the heel. The majority of individuals affected by the condition complains of pain when walking up and down the stairs. It can occur in conjunction with plantar fasciitis in adults or calcaneal apophysitis in young athletes.

 

Additionally, it can be mistaken for some of the conditions below:

 

  • Nerve entrapment

  • Bone marrow edema (bone bruise)

  • Haglund’s deformity

  • Stress fracture

 

What are my options?

 

Quite often, if you decrease your activities, ice the area, and try over the counter anti-inflammatory, the symptoms can resolve themselves. If symptoms fail to resolve within two weeks, it is highly recommended that you see a podiatrist for treatments so you can bounce back to normal and daily life activities faster.

 

With advance in technology, treatments for Achilles tendinitis can be pain-free. Also keep in mind that the sooner you come in for an evaluation, the easier and faster it is for you to return to normal day-to-day activities.

 

Depending on your presentation upon evaluation, some of the treatment options include but not limited to:

 

  • Biomechanical adjustment with padding

  • Immobilization

  • Connective tissue injection

  • Custom inserts

  • Dorsal splint

  • Heel lifts

  • Prescription medication

  • Physical therapy

Nerve Entrapment

 

What is nerve entrapment?

 

Nerve entrapment is when a nerve is compressed or restricted. In the lower extremity, this may happen to many types of nerves; however, the most common one is the tibial nerve. When the tibial nerve is compressed, the condition is referred to as tarsal tunnel syndrome.

 

What causes nerve entrapment?

 

Nerve entrapment can be caused by trauma, surgery, abnormal soft tissue growth (e.g. a cyst compressing the nerve), injury, or overuse.

 

What are the common symptoms?

 

Nerve entrapment can present as shooting, pins and needles, numbness, burning, or radiating pain. The pain can shoot up or down the area. With tarsal tunnel syndrome, it can presents as heel pain.

 

What are my options?

 

With nerve entrapment, it is unlikely that you can treat it successfully at home. It is highly recommended that you see a podiatrist immediately to prevent worsening of the symptoms. Depending on the cause of the impingement, treatment options include but not limited to:

 

  • Steroid injection

  • Padding

  • Custom inserts

  • Surgery

Bone Marrow Edema

 

What is bone marrow edema?

 

Bone marrow edema is a bone bruise. If left untreated, it may turn into a fracture.

 

What causes bone marrow edema?

 

Bone marrow edema is caused by repetitive microtrauma to the bone or sudden trauma to the heel bone (e.g. a dancer or gymnast landing on the heel).

 

What are common symptoms?

 

Bone marrow edema presents as pain in the heel, either on the sides or the bottom. The pain can be so painful that you will not be able to walk.

 

What are my options?

 

With bone marrow edema, decreasing your activity, icing the area, and taking over-the-counter pain medications can help with symptoms. If symptoms do not improve in two weeks, it is highly recommended that you see a podiatrist to prevent worsening of the condition. You will likely be immobilized for a period of time, depending on the severity of the condition. Imaging will be taken at the time of your evaluation to help determine the best treatment plan for you.

 

Calcaneal Apophysitis

 

What is calcaneal apophysitis?

 

Calcaneal apophysitis, also known as Sever’s disease, is the inflammation of the heel bone growth plate. This condition affects young athletes.

 

What causes calcaneal apophysitis?

 

Calcaneal apophysitis is caused by microtrauma - repetitive pulling of the Achilles tendon on the growth plate. A tight Achilles tendon can lead to the development of calcaneal apophysitis. 

 

How does it present?

 

Calcaneal apophysitis presents as pain in the back of the heel. Pain can occur with running, jumping, and other high impact activities. For the majority of the time, the condition occurs in both heels. It can sometimes occur in conjunction with plantar fasciitis or Achilles tendinitis in young athletes.

 

What are my options?

 

For the majority of the time, if you decrease your activities, stretch, ice the area, and try over-the-counter anti-inflammatory drugs, the symptoms can resolve itself. If symptoms fail to resolve within two weeks, it is highly recommended that you see a podiatrist for treatments so you can bounce back to your normal activities faster.

 

Depending on your presentation upon evaluation, some of the treatment options include but not limited to:

 

  • Heel lift

  • Immobilization

  • Connective tissue injection

  • Custom inserts

  • Dorsal splint

  • Prescription medication

  • Physical therapy

Haglund’s Deformity

 

What is Haglund’s deformity?

 

Haglund’s deformity is recognized as a large bony enlargement in the back of the heel. It is also called a pump bump. Because of the location of the deformity, pain is usually present with rigid shoe gear - high heels, men’s dress shoes, and shoes without a back cushion. It may present in conjunction with Achilles tendinitis.

 

What causes Haglund’s deformity?

 

The cause of the condition is unknown; however, individuals with a prominent heel bone or a tight Achilles tendon are more prone to developing the condition.

 

What are common symptoms?

 

Haglund’s deformity presents as pain in the back of the heel. There may even be a recognizable or palpable bump.

 

What are my options?

 

Conservatively, wearing open back shoe gear or shoe gear with ample heel cushion can help with the pain. However, if these do not help and the condition is affecting your quality of life, please see a podiatrist to see if there is anything else that can be done prior to surgery.

 

Stress Reaction

 

What is calcaneal stress fracture?

 

Calcaneal stress fracture is a microfracture in the heel bone. It can take up to 14 days before you can see the fracture line on X-rays. However, there are physical exams that can confirm or rule out the stress fracture.

 

What causes calcaneal stress fracture?

 

Calcaneal stress fracture is caused by repetitive microtrauma to the bone. Keep in mind that a stress fracture can happen anywhere in the foot.

 

What are the common symptoms?

 

Calcaneal stress fracture presents as pain in the heel, either on the sides or the bottom. The pain can be limiting to where it is affecting your daily activities.

 

What are my options?

 

With calcaneal stress fracture, decreasing your activity is the only way to help prevent the condition from worsening. However, if the condition fails to improve, it is highly recommended that you see a podiatrist to evaluate the extent of the fracture and the severity. If the condition is concerning, it is likely that you will be immobilized for a period of time with serial x-rays to prevent worsening of the symptoms

Achilles Tendinitis
Nerve Entrapment
Bone Marrow Edema
Calcaneal Apophysitis
Haglund's Deformity
Stress Reaction
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