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Our feet are designed to act as shock absorbers and are able to handle very heavy loads. We often push past the limit by running or playing sports on very hard surfaces or wearing shoes / flip-flops that are not supportive or are of improper size leading to a multitude of foot and ankle problems.
The most common foot and ankle complaint of those presenting to The Foot & Ankle Center, PC in Pooler GA, and to foot & ankle specialists nationally, is heel pain. It can also be one of the most complex problems to treat because of the multiple causes as well as the typical delay in seeking treatment. When the early signs of heel pain are ignored the symptoms usually get worse and may often lead to other foot and ankle problems caused by compensation.
There are two categories of heel pain: pain on the bottom (plantar) and pain on the back of the heel bone (calcaneus). The most common cause pain on the bottom of the heel is plantar fasciitis or better known as heel spur syndrome. Another common cause is nerve entrapment (~70% of patients have both plantar fasciitis and nerve entrapment) and less commonly, stress fracture, arthritis, tendonitis, a cyst or a combination of these. Pain on the back of the heel most often involves the insertion of the Achilles tendon into the bone. Due to the multi-factorial nature of heel pain, the earlier a diagnosis is made, the better the outcome.
A sharp stabbing pain, like a nail going into the bottom of the heel when first stepping on the foot after getting out of bed or after sitting for period of time, is the most common description for plantar fasciitis or heel spur syndrome. Typically the pain eases off as the day goes on but it may not go away completely. A thick ligament that attaches to the bottom of the heel and runs the length of the foot to the toes can become inflamed and swollen at the attachment site. This tends to be an overuse type of injury where poor foot structure is involved; also, wearing of shoe gear that lacks adequate support (ie: worn out shoes, boots and flip-flops) and prolonged standing or walking are often implicated.
A throbbing pain that gets worse as the day goes on and can be worse at night when laying in bed is most often associated with an irritated or entrapped nerve on the inside of the ankle or heel. This is similar to carpel tunnel syndrome in the wrist and hand. Approximately 7 / 10 patients with heel pain have a component of nerve entrapment as the cause of their heel pain. This is also one of the most common causes of chronic heel pain because it is often missed as a diagnosis. When nerve entrapment is considered to be a cause, painless neurosensory testing is performed with the Pressure Specified Sensory Device™ (PSSD) at The Foot & Ankle Center, PC to determine the extent of compression.
A less common cause of heel pain but a stress fracture is often considered in athletes, such as long distance runners, who have heel pain.
This is pain in the back of the heel that flares up when first starting an activity. It is often associated with a large bump that can be irritated by shoes. The Achilles tendon attaches to the back of the heel and, like on the bottom, this attachment site can often become inflamed; a spur may or may not be present. Another painful area is a sac of fluid (bursa) that sits between the tendon and bone to act as a cushion for the tendon. This bursa can become inflamed often leading to significant pain called retrocalcaneal bursitis.
Treatment of heel pain must be directed at the specific cause of your problem. If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations, you should seek medical attention. You should call Dr. Talarico for an appointment if you experience any of the following:
The proper treatment for your heel pain depends entirely on the specific cause(s) of your symptoms. Therefore, it is critical to understand the cause(s) of your symptoms before beginning any treatment program and if you are unsure, then seeking medical advice is essential to develop the proper treatment program for your condition.
Some common treatments are listed and can be performed at home. Keep in mind that not all of these treatments are appropriate for every condition, but they usually a good place to start.
If the pain persists or worsens after a couple of days, an appointment may be necessary where Dr. Talarico may add one or more of these additional modalities to your treatment program:
When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don’t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve , and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.
It is important to keep in mind that even if heel pain is resolved, it may return. Therefore, continuing with preventative measures such as proper shoe gear, stretching exercises and using a custom orthotic will help reduce the likelihood of its return.
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