There are 26 bones, 33 joints and more than 100 tendons, muscles, and ligaments in the human foot. The heel bone is the largest of all 26 bones in the foot and like all bones, outside influences can wreak havoc on its strength and ability. Heel pain, located in the front, back, or bottom of the heel is often disabling and can disrupt one’s whole lifestyle.
Heel pain is generally caused by faulty biomechanics (an abnormality in your gait). These abnormalities can put too much stress on the heel bone and soft tissues that attach to the bone. Stress can result from injury, bruising, wearing poorly constructed footwear, or being overweight.
What are the common heel pain causes?
There are many common causes of heel pain including; heel spurs, plantar fasciitis, excessive pronation, and Achilles tendinitis.
Heel spurs are bony growths on the underside of the heel bone. The spur is visible on x-ray and appears as a small protrusion extending forward as much as half an inch. When there is no enlargement of the bone, the condition is referred to as “heel spur syndrome.”
These spurs result from strain on the muscles and ligaments of the foot, because there is a long band connecting the ball of the foot and heel that is being overstretched. This leads to repeated tearing of the lining and membrane that covers the heel bone. Conditions such as these occur for many reasons such as biomechanical imbalances, exercising, improper shoe gear, and obesity.
A common foot condition is Plantar Fasciitis. Heel pain and spurs are frequently associated with plantar fasciitis. Plantar fasciitis is an inflammation of a fibrous connective tissue bands (fascia) that run from the heel to the ball of the foot. This inflammation is common among athletes who run and jump often. This condition occurs when the plantar fascia is strained over time beyond normal extension. This continual strain will cause the soft tissue fibers to tear and stretch at points along its length. This can cause inflammation, pain, and the possible growth of a bone spur where the plantar fascia attaches to the heel bone. Such inflammation can get aggravated by shoes which lack appropriate support in various areas, especially the arch.
With plantar fasciitis, resting can provide only temporary relief. Upon walking, especially after a night’s sleep, you can experience a sudden lengthening of the fascia band, which stretches and pulls on the heel. When walking, the heel pain can lessen or disappear, but it is usually a false sense of relief. The pain will return after extended rest or a substantial amount of walking,
Heel pain can sometimes result from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot. It allows your foot to adapt to ground surfaces and absorb shock in your normal walking pattern. As we walk, our heel contacts the ground first, shifting the weight from the outside of the foot, then to our big toe. Your arch will then rise and your foot will roll upward and outward, becoming stable to lift the body and move it forward. Excessive pronation and inward motion, creates an irregular amount of stretching and pulling on ligaments and tendons attaching to the back bottom of the heel bone. This excessiveness can also contribute to hip, knee, and lower back injuries.
Pain at the back of the heel can also be associated with Achilles Tendinitis. Achilles Tendinitis is an inflammation of the Achilles tendon that runs along the back of the ankle and inserts into the back surface of the heel bone. It is usual for this to occur when the tendon is strained over time. This causes the fibers to tear and stretch along its length or at its insertion on the heel bone. This condition leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. This inflammation can become aggravated by chronic irritation that sometimes accompanies someone with an active lifestyle or certain activities that strain already tight tendons.
There are also many other causes of heel pain;
- various forms of arthritis
- inflamed bursa
- haglund’s deformity
- bone bruise or contusion
When should you visit a doctor?
You should visit a podiatrist if pain and other inflammation, redness, swelling, or heat persist and limit your daily activities. A podiatrist will examine the area and may perform x-rays to rule out bone issues.
Some early treatment options available are oral or injectable anti-inflammatory medication, exercise, and supportive shoe gear. Taping or strapping of these areas, shoe inserts or orthotic devices may all support the foot, placing stressed muscles and tendons in a relaxed state. Your podiatrist may recommend physical therapy in conjunction with such treatments.
Orthotic devices can be prescribed for correcting biomechanical imbalance. They also can correct excessive pronation, support ligaments and tendons, and treat the majority of heel and arch pain without the need for surgery.
There are only a few cases of heel pain which require more advanced treatments or surgery. Some surgical treatments may include; release of the plantar fascia, removal of a spur, removal of a bursa, neuroma, or other soft-tissue growth.
Heel pain prevention
Some key things to remember when preventing heel pain and similar issues are wearing shock absorbent soled shoes that fit well. Wearing the proper shoes for a certain activity plays a big role in prevention as well. You want to avoid any shoes with excessive wearing down on the heels or soles. You should prepare properly before exercising by warming up and doing some stretching before and after running. Being obese will also lead to these issues, so it’s important to maintain a healthy lifestyle and lose weight if you are obese.