Heel Pain The Causes, Signs Or Symptoms And Cure Options

Overview


Painful Heel


Heel Pain is common and has many causes. Typically, these problems are easily solved by rest or simple exercises. Pain may occur in two places - beneath or under the heel. Inflammation of tissues on the foot?s bottom produces pain beneath the heel. Common causes include bruises, injury to tissue connecting toes and heel bone (referred to as plantar fasciitis), or calcium deposits resulting from extended plantar fasciitis. Under-the-heel pain comes from inflammation where the Achilles tendon meets the heel bone.


Causes


In the majority of cases, heel pain has a mechanical cause. It may also be caused by arthritis, infection, an autoimmune problem trauma, a neurological problem, or some other systemic condition (condition that affects the whole body).


Symptoms


See your doctor as soon as possible if you experience severe pain accompanied by swelling near your heel. There is numbness or tingling in the heel, as well as pain and fever. There is pain in your heel as well as fever. You are unable to walk normally. You cannot bend your foot downwards. You cannot stand with the backs of the feet raised (you cannot rise onto your toes). You should arrange to see a doctor if the heel pain has persisted for more than one week. There is still heel pain when you are not standing or walking.


Diagnosis


Depending on the condition, the cause of heel pain is diagnosed using a number of tests, including medical history, physical examination, including examination of joints and muscles of the foot and leg, X-rays.


Non Surgical Treatment


Heel pain often goes away on its own with home care. For heel pain that isn't severe, try the following. Rest. If possible, avoid activities that put stress on your heels, such as running, standing for long periods or walking on hard surfaces. Ice. Place an ice pack or bag of frozen peas on your heel for 15 to 20 minutes three times a day. New shoes. Be sure your shoes fit properly and provide plenty of support. If you're an athlete, choose shoes appropriate for your sport and replace them regularly. Foot supports. Heel cups or wedges that you buy in the drugstore often provide relief. Custom-made orthotics usually aren't needed for heel problems. Over-the-counter pain medications. Aspirin or ibuprofen (Advil, Motrin IB, others) can reduce inflammation and pain.


Surgical Treatment


If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints or a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as open surgery, where the section of the plantar fascia is released by making a cut into your heel or endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team.


Prevention


Foot Pain


It may not be possible to prevent all cases of heel pain. However, there are some easy steps that you can take to avoid injury to the heel and prevent pain. Whenever possible, you should wear shoes that fit properly and support the foot, wear the right shoes for physical activity, stretch your muscles before exercising, pace yourself during physical activity, maintain a healthy diet, rest when you feel tired or when your muscles ache, maintain a healthy weight.

Achilles Tendonitis

Overview


Achilles TendonAchilles tendinitis. Achilles tendonitis is inflammation of the Achilles tendon, the largest tendon in the body, which runs from the calf to the heel bone. Noninsertional Achilles tendonitis affects fibers in the middle of the tendon. Insertional Achilles tendonitis affects the lower portion of the tendon where it attaches to the heel bone. Both types can result from repetitive stress to the tendon or from overstressing the tendon during exercise. Damaged tendon fibers can calcify and bone spurs can form where the tendon attaches to the bone. Symptoms may include pain and stiffness of the tendon - which may occur from either inactivity (such as first thing in the morning) or after activity - thickening or swelling of the tendon or bone spurs.


Causes


Achilles tendinitis is caused by repeated stress to the tendon, not a direct injury. Often times, this can happen from doing too much too soon and not giving your body enough time to rest or adjust to the increase in intensity or amount of exercise. Another contributing factor can be tight calf muscles. Having tight calf muscles and starting an activity can put added stress on the achilles tendon.


Symptoms


If you have Achilles tendinitis or Achilles enthesopathy, you are likely to experience the following symptoms. Pain. You may notice aching, burning, or tearing pains at the back of your heel or above the ankle. The pain can range from mild to very severe and disabling. It is most noticeable in the following circumstances. After resting. Many people report that pain increases when they first get out of bed in the morning or after sitting for a period of time. After exercise. Pain may increase if you exercise or stand for a period of time. A lump. In some cases, a tender lump can develop at the site of the injured tendon (tendinosis). Bone spurs. When the injury occurs at the point where the tendon attaches to the foot, a bone spur may develop on the heel.


Diagnosis


Studies such as x-rays and MRIs are not usually needed to make the diagnosis of tendonitis. While they are not needed for diagnosis of tendonitis, x-rays may be performed to ensure there is no other problem, such as a fracture, that could be causing the symptoms of pain and swelling. X-rays may show evidence of swelling around the tendon. MRIs are also good tests identify swelling, and will show evidence of tendonitis. However, these tests are not usually needed to confirm the diagnosis; MRIs are usually only performed if there is a suspicion of another problem that could be causing the symptoms. Once the diagnosis of tendonitis is confirmed, the next step is to proceed with appropriate treatment. Treatment depends on the specific type of tendonitis. Once the specific diagnosis is confirmed, the appropriate treatment of tendonitis can be initiated.


Nonsurgical Treatment


NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions. Steroid injections. Steroids decrease pain and swelling. After you get this shot, you may feel like your Achilles tendon is healed. Do not return to your regular exercise until your caregiver says it is okay. You could make the tendinitis worse, or even tear the tendon. Surgery. If your tendinitis does not heal with other treatments, you may need surgery. Surgery may be done to repair a tear in the tendon, or to remove parts of the tendon. The most important way to manage Achilles tendinitis is to rest. Rest decreases swelling and keeps your tendinitis from getting worse. You may feel pain when you begin to run or exercise. The pain usually goes away as your muscles warm up, but it may come back. Your caregiver may tell you to stop your usual training or exercise activities. He may give you other exercises to do until your Achilles tendon heals. Ice decreases swelling and pain. Put ice in a plastic bag. Cover it with a towel. Put this on your Achilles tendon for 15 to 20 minutes, 3 to 4 times each day. Do this for 2 to 3 days or until the pain goes away. After 2 or 3 days, you may use heat to decrease pain and stiffness. Use a hot water bottle, heating pad, whirlpool, or warm compress. To make a compress, soak a clean washcloth in warm water. Wring out the extra water and put it on your Achilles tendon 15 to 20 minutes, 3 to 4 times each day. Stretching and making the muscles stronger may help decrease stress on your Achilles tendon. Physical therapists can teach you exercises and treatments to help your tendinitis heal faster. You may need to wear inserts in your shoes. You may need to wrap tape around your heel and back of the leg. You may need to wear a cast, brace, or support boot.


Achilles Tendonitis


Surgical Treatment


In cases of severe, long-term Achilles tendonitis the sheath may become thick and fibrous. In these cases surgery may be recommended. Surgery aims to remove the fibrous tissue and repair any tears in the tendon. A cast or splint will be required after the operation and a recovery program including physiotherapy, specific exercises and a gradual return to activity will be planned.


Prevention


A 2014 study looked at the effect of using foot orthotics on the Achilles tendon. The researchers found that running with foot orthotics resulted in a significant decrease in Achilles tendon load compared to running without orthotics. This study indicates that foot orthoses may act to reduce the incidence of chronic Achilles tendon pathologies in runners by reducing stress on the Achilles tendon1. Orthotics seem to reduce load on the Achilles tendon by reducing excessive pronation,
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