What are the main causes of plantar fasciitis. How can you recognize the symptoms of this condition. What are the most effective treatments for plantar fasciitis. When should you consider surgery for persistent heel pain. How can you prevent plantar fasciitis from recurring.

Understanding Plantar Fasciitis: The Common Culprit Behind Heel Pain

Plantar fasciitis is a prevalent condition that affects countless individuals, causing significant discomfort and impacting daily activities. This inflammatory condition targets the plantar fascia, a thick band of tissue that extends from the heel to the toes, playing a crucial role in supporting the foot’s arch.

When the plantar fascia becomes irritated and inflamed, it results in heel pain that can range from mild discomfort to sharp, stabbing sensations. While plantar fasciitis is often the primary cause of heel pain, it’s essential to recognize that other conditions may also be responsible.

What distinguishes plantar fasciitis from other heel pain causes?

Plantar fasciitis is characterized by its specific location and pattern of pain. However, other conditions such as stress fractures, tendonitis, arthritis, nerve irritation, or cysts can also cause heel pain. Due to this variety of potential causes, it’s crucial to obtain a proper diagnosis from a foot and ankle surgeon who can differentiate between these possibilities and identify the root cause of your discomfort.

The Root Causes of Plantar Fasciitis: Unraveling the Mystery

Understanding the underlying causes of plantar fasciitis is essential for both prevention and effective treatment. While multiple factors can contribute to the development of this condition, some are more common than others.

How does foot structure contribute to plantar fasciitis?

The most prevalent cause of plantar fasciitis is related to the foot’s structure. Individuals with arch problems, such as overly flat feet (pes planus) or high-arched feet (pes cavus), are more susceptible to developing plantar fasciitis. These structural abnormalities can place excessive stress on the plantar fascia, leading to inflammation and pain.

What role does footwear play in the development of plantar fasciitis?

Wearing inappropriate footwear, particularly shoes that lack proper support, can significantly contribute to the onset of plantar fasciitis. This is especially true when walking or standing on hard, flat surfaces for extended periods. Occupations that require long hours on one’s feet can exacerbate this risk, highlighting the importance of proper footwear in prevention.

Are there lifestyle factors that increase the risk of plantar fasciitis?

Yes, certain lifestyle factors can increase the likelihood of developing plantar fasciitis. Obesity is a significant risk factor, as excess weight places additional stress on the plantar fascia. Additionally, overuse or sudden increases in physical activity, particularly those involving repetitive impact on the feet, can lead to the condition.

Recognizing the Symptoms: Key Indicators of Plantar Fasciitis

Identifying the symptoms of plantar fasciitis is crucial for early intervention and effective management. While the presentation may vary slightly from person to person, there are several common indicators to watch for.

• Pain on the bottom of the heel
• Discomfort in the arch of the foot
• Pain that is typically worst upon waking or after periods of inactivity
• Gradual increase in pain intensity over several months
• Swelling on the bottom of the heel

Why is morning pain a hallmark symptom of plantar fasciitis?

Many individuals with plantar fasciitis report that their pain is most severe when they first get out of bed in the morning or after sitting for extended periods. This occurs because the plantar fascia tightens during periods of rest. As you begin to move and stretch the fascia, the pain often subsides, only to potentially return after prolonged periods of standing or physical activity.

Diagnosing Plantar Fasciitis: The Importance of Professional Assessment

Obtaining an accurate diagnosis is crucial for effective treatment of plantar fasciitis. A foot and ankle surgeon will employ various methods to determine the cause of your heel pain and rule out other potential conditions.

What does the diagnostic process for plantar fasciitis involve?

The diagnostic process typically begins with a thorough medical history and physical examination of the foot. During this assessment, the surgeon will carefully evaluate your symptoms, examine the structure of your foot, and test for areas of tenderness or pain. They may also observe your gait and foot mechanics to identify any contributing factors.

In some cases, diagnostic imaging studies such as X-rays or other advanced imaging modalities may be utilized to distinguish between different types of heel pain and rule out other conditions. It’s worth noting that while heel spurs are sometimes found in patients with plantar fasciitis, they are rarely the source of pain themselves.

Effective Non-Surgical Treatments for Plantar Fasciitis

The majority of plantar fasciitis cases can be successfully managed with non-surgical interventions. Treatment typically begins with conservative approaches that patients can implement at home.

What are the first-line treatment strategies for plantar fasciitis?

1. Stretching exercises: Regular stretching of the calf muscles and plantar fascia can help alleviate pain and promote recovery.
2. Avoiding barefoot walking: Going barefoot places additional strain on the plantar fascia, so wearing supportive footwear is recommended.
3. Ice therapy: Applying ice to the affected area for 20 minutes several times a day can help reduce inflammation and pain.
4. Activity modification: Temporarily reducing high-impact activities allows the plantar fascia time to heal.
5. Shoe modifications: Wearing supportive shoes with good arch support and a slightly raised heel can help reduce stress on the plantar fascia.
6. Over-the-counter medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and inflammation.

What additional treatments might a foot and ankle surgeon recommend?

If initial home treatments don’t provide sufficient relief, your foot and ankle surgeon may suggest one or more of the following interventions:

• Padding, taping, and strapping to provide additional support to the foot
• Custom orthotic devices to correct underlying structural abnormalities
• Corticosteroid injections to reduce inflammation and alleviate pain
• Removable walking cast to immobilize the foot and promote healing
• Night splints to maintain a stretch of the plantar fascia during sleep
• Physical therapy exercises and modalities to provide relief and improve function

When Surgery Becomes Necessary: Understanding Surgical Options

While the vast majority of plantar fasciitis cases respond well to non-surgical treatments, a small percentage of patients may require surgical intervention. Understanding when surgery becomes a viable option is crucial for those dealing with persistent heel pain.

Under what circumstances is surgery considered for plantar fasciitis?

Surgery is typically only considered after several months of consistent, non-surgical treatment have failed to provide adequate relief. If you continue to experience significant pain and limitations in your daily activities despite exhausting conservative options, your foot and ankle surgeon may discuss surgical alternatives.

What does plantar fasciitis surgery involve?

The most common surgical procedure for plantar fasciitis is a plantar fascia release. This operation involves partially cutting the plantar fascia ligament to relieve tension and reduce inflammation. In some cases, this may be combined with the removal of heel spurs if present, although spurs are rarely the primary cause of pain.

Surgical techniques can vary, with some surgeons preferring minimally invasive approaches using small incisions or endoscopic methods. The specific technique chosen will depend on your individual case and your surgeon’s expertise.

What is the recovery process like after plantar fasciitis surgery?

Recovery from plantar fasciitis surgery typically involves a period of rest and limited weight-bearing, followed by a gradual return to normal activities. The exact timeline can vary depending on the surgical technique used and individual healing rates, but most patients can expect:

• 1-2 weeks of rest with elevation and ice therapy
• 2-6 weeks of limited weight-bearing, often with the use of crutches or a surgical boot
• 6-12 weeks for a return to normal shoe wear and activities
• Several months for complete recovery and resolution of symptoms

Physical therapy is often prescribed during the recovery period to help regain strength, flexibility, and proper foot mechanics.

Preventing Recurrence: Long-Term Management of Plantar Fasciitis

After successfully treating plantar fasciitis, taking steps to prevent its recurrence is crucial for maintaining foot health and avoiding future discomfort. Implementing long-term strategies can significantly reduce the risk of the condition returning.

How can you minimize the risk of plantar fasciitis recurrence?

Several preventive measures can help keep plantar fasciitis at bay:

1. Maintain a healthy weight to reduce stress on your feet
2. Wear supportive, well-fitting shoes appropriate for your activities
3. Replace athletic shoes regularly, especially if you’re a runner or engage in high-impact sports
4. Stretch your calves and plantar fascia daily, particularly before and after exercise
5. Gradually increase the intensity and duration of your physical activities
6. Use custom orthotics if prescribed by your foot and ankle surgeon
7. Avoid going barefoot, especially on hard surfaces
8. Consider low-impact exercises like swimming or cycling to maintain fitness while reducing foot stress

Why is ongoing foot care important for those with a history of plantar fasciitis?

Individuals who have experienced plantar fasciitis are at a higher risk of recurrence. Ongoing foot care and awareness are essential for maintaining foot health and preventing future episodes. This may include regular check-ups with a foot and ankle specialist, particularly if you notice any recurring symptoms or changes in your foot structure or function.

Exploring Alternative and Complementary Therapies for Plantar Fasciitis

While traditional medical treatments form the cornerstone of plantar fasciitis management, some patients find additional relief through alternative and complementary therapies. These approaches can often be used in conjunction with conventional treatments to provide a more comprehensive care plan.

What alternative therapies show promise for plantar fasciitis treatment?

Several alternative therapies have gained attention for their potential benefits in managing plantar fasciitis:

• Acupuncture: This traditional Chinese medicine technique involves inserting thin needles into specific points on the body to alleviate pain and promote healing.
• Massage therapy: Deep tissue massage of the plantar fascia and surrounding muscles can help reduce tension and improve circulation.
• Extracorporeal shock wave therapy (ESWT): This non-invasive treatment uses sound waves to stimulate healing in the affected tissue.
• Platelet-rich plasma (PRP) injections: This treatment uses a concentration of the patient’s own platelets to promote healing in the plantar fascia.
• Dry needling: Similar to acupuncture, this technique targets trigger points in the muscles to relieve pain and improve function.

How effective are these alternative therapies for plantar fasciitis?

The effectiveness of alternative therapies can vary from person to person, and scientific evidence supporting their use is mixed. Some patients report significant relief from these treatments, while others may not experience the same benefits. It’s important to discuss any alternative therapies with your foot and ankle surgeon before incorporating them into your treatment plan to ensure they are appropriate for your specific case and do not interfere with other treatments.

The Impact of Plantar Fasciitis on Daily Life and Athletic Performance

Plantar fasciitis can have a significant impact on an individual’s quality of life, affecting both daily activities and athletic performance. Understanding these effects is crucial for patients and healthcare providers in developing comprehensive management strategies.

How does plantar fasciitis affect everyday activities?

The pain associated with plantar fasciitis can make simple daily tasks challenging. Activities such as walking, standing for extended periods, or climbing stairs can become painful and difficult. This can lead to:

• Reduced mobility and independence
• Difficulty performing job duties, especially in occupations that require long periods of standing or walking
• Decreased participation in social and recreational activities
• Potential changes in gait or posture to avoid pain, which may lead to secondary issues in other parts of the body

What is the impact of plantar fasciitis on athletic performance?

For athletes and fitness enthusiasts, plantar fasciitis can be particularly frustrating. The condition can significantly impact performance and training in several ways:

• Reduced speed and agility due to pain and discomfort
• Decreased endurance as pain worsens with prolonged activity
• Limitations in training intensity and frequency
• Potential for compensatory injuries as athletes alter their movement patterns to avoid pain
• Extended recovery times between workouts or competitions

Athletes with plantar fasciitis often need to modify their training regimens and may require extended periods of rest or alternative low-impact activities to maintain fitness while allowing the condition to heal.

How can individuals with plantar fasciitis adapt their lifestyle and training?

Adapting to life with plantar fasciitis often requires a multifaceted approach:

1. Modifying daily routines to minimize prolonged standing or walking
2. Using supportive footwear and orthotics consistently, even at home
3. Incorporating regular stretching and self-massage into daily routines
4. Exploring low-impact exercise alternatives such as swimming, cycling, or yoga
5. Working with a physical therapist or athletic trainer to develop modified workout plans
6. Gradually returning to higher-impact activities as symptoms improve, under professional guidance

By making these adaptations and working closely with healthcare providers, individuals with plantar fasciitis can often manage their symptoms effectively and maintain an active lifestyle.

Plantar Fasciitis – Heel Pain | Foot Health Facts

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Heel pain, especially stabbing heel pain, is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation or, rarely, a cyst.

Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is able to distinguish between all the possibilities and to determine the underlying source of your heel pain.

What Is Plantar Fasciitis?

Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.

Causes of Plantar Fasciitis

The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.

Wearing nonsupportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity and overuse may also contribute to plantar fasciitis.

Symptoms of Plantar Fasciitis

The symptoms of plantar fasciitis are:

• Pain on the bottom of the heel
• Pain in the arch of the foot
• Pain that is usually worse upon arising
• Pain that increases over a period of months
• Swelling on the bottom of the heel
  
   

People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they have been sitting for long periods of time. After a few minutes of walking, the pain decreases because walking stretches the fascia. For some people, the pain subsides but returns after spending long periods of time on their feet.

Diagnosis of Plantar Fasciitis

To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process, the surgeon rules out all possible causes for your heel pain other than plantar fasciitis.

In addition, diagnostic imaging studies, such as x-rays or other imaging modalities, may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Nonsurgical Treatment

Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:

• Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
• Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
• Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.
• Limit activities. Cut down on extended physical activities to give your heel a rest.
• Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
• Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
  
   

If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches:

• Padding, taping and strapping. Placing pads in the shoe softens the impact of walking. Taping and strapping help support the foot and reduce strain on the fascia.
• Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
• Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
• Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
• Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
• Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
  
   

When Is Surgery Needed?

Although most patients with plantar fasciitis respond to nonsurgical treatment, a small percentage of patients may require surgery. If, after several months of nonsurgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.

Long-Term Care

No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

Why choose a foot and ankle surgeon?

Foot and ankle surgeons are the leading experts in foot and ankle care today. As doctors of podiatric medicine – also known as podiatrists, DPMs or occasionally “foot and ankle doctors” – they are the board-certified surgical specialists of the podiatric profession. Foot and ankle surgeons have more education and training specific to the foot and ankle than any other healthcare provider.

Foot and ankle surgeons treat all conditions affecting the foot and ankle, from the simple to the complex, in patients of all ages including plantar fasciitis, heel pain and stabbing heel pain. Their intensive education and training qualify foot and ankle surgeons to perform a wide range of surgeries, including any surgery that may be indicated for plantar fasciitis or heel pain.

Get Relief From Heel Pain

The average person takes about 8,000 steps per day—a distance of roughly four miles. In two years, you’ll probably have walked far enough to make it from McPherson to New York City—and back! After a lifetime on your feet, you’ll have logged enough miles to circle the earth four, maybe five times.

So, it shouldn’t be much of a surprise that heel pain is both very common and quite a detriment to quality of life.  Heel pain may manifest as a sharp, stabbing sensation when you get out of bed in the morning, as burning or tingling, or as an ache that progressively gets worse over the course of the day.

Fortunately, it is very treatable. If heel pain is limiting your activity or causing you discomfort, give us a call.

Common Heel Pain Causes

The most frequent underlying cause of heel pain is overuse or overexertion. In other words, when you place too much force and pressure on the heels over too short a period of time, without giving your heels adequate time to rest or recover, chronic pain can set in.

There are many factors that could lead to this state of affairs—far too many to list on a single page. However, these are some of the most common:

• Wearing shoes that don’t provide adequate support or cushioning for your activity—like flip flops, for example, instead of comfortable walking shoes.
• Working a job that requires a lot of standing and walking.
• Playing sports or having active hobbies that require a lot of running and jumping, particularly on hard surfaces or difficult terrain.
• Dramatically increasing your activity level or changing your exercise routine without gradually conditioning your body to handle the strain first.
• Foot shapes or biomechanical flaws that leave you more prone to developing heel pain. This might include flat or high arches, overpronation, landing too hard on your heels when you run, etc.
• Being overweight.

Common Heel Pain Diagnoses

While overuse tends to be the underlying cause in most cases, there are also a variety of different clinical diagnoses that can be responsible for the symptoms. It all depends on what specific part of the body has been injured, and how severe it is.

 

• Plantar fasciitis is the most common cause of heel pain along the underside of the heel, and is the result of a damaged plantar fascia ligament. The plantar fascia tightens up at night, so the first steps of the morning often cause sharp pain.
• Achilles tendinitis affects the back of the heel, specifically the “heel cord” behind the ankle. It is caused by swelling and inflammation in the tendon that connects the heel bone to the calf muscle.
• Bursitis symptoms are very similar to those of Achilles tendinitis. However, the cause of this condition is inflamed bursae, which are fluid-filled pads that cushion muscles and tendons near the heel.
• Heel spurs are bony projections that form at the front of the heel bone and point toward the arch. They may form in response to chronic plantar fasciitis, and are not always painful on their own. They can be detected via X-ray.
• Compressed nerves, also known as pinched nerves, can lead to tingling or burning pain in the heels and feet. Nerves that run through narrow tubes and tunnels in the ankle are especially vulnerable to physical pinching or obstruction.

Treating Heel Pain

The specific techniques we may recommend to address your heel pain will depend on the condition and cause of the symptoms, how the pain is affecting your life, what treatments have already been attempted, and other factors. Personalizing treatment to the needs of each individual helps us achieve the best possible outcomes for our patients!

That said, a “general” game plan for addressing heel pain in a fairly typical scenario might look like this:

Home Care

Whenever you notice heel pain beginning to develop, you may wish to attempt home treatment first. Taking care of yourself as soon as possible can help prevent heel pain from progressing to a more serious stage.

 

• Slow down, avoid strenuous physical activities that cause pain. Prop your feet up or rest them on a pillow when you sit or sleep.
• If you notice swelling, try applying ice for about 15 minutes, 2-3 times per day.
• Avoid shoes that are too tight (or too loose), don’t support your feet, don’t cushion your heel, or just aren’t appropriate for your chosen activity.

Further Care Options

If heel pain is severe, or keeps returning despite home care, you may need further care from our team. We always start with conservative treatments, which may include options such as:

• Stretching
• Wrapping
• Anti-inflammatory medications
• Physical therapy
• Cortisone injections
• Laser therapy—this is an advanced, painless, and virtually risk-free treatment that helps stimulate your body’s naturally healing processes to trigger rapid improvement in most patients. It’s especially loved by athletes and those who work on their feet.

 

In many cases, once the painful symptoms have been reduced or eliminated, we will prescribe custom orthotics to correct any underlying biomechanical issues causing heel pain in the first place. These devices are custom-molded to the exact shape of your feet and slide right into your shoes. They place your feet in a more natural position and improve ergonomics and alignment throughout your entire skeleton—not just your feet.

Most of our patients respond positively to conservative treatments; surgery is only rarely necessary. The longer you wait to receive treatment, however, the more likely your condition will become chronic and require more aggressive intervention.

At Community Foot Clinic of McPherson, we understand the difficulty of heel pain. Call 620-241-3313 or request an appointment online today!

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Heel pain

Heel pain. “The feeling of a driven nail with every step”! – this is how patients describe heel pain and believe that it occurs only because of the heel spur. What is a spur? The plantar fascia originates from the median protrusion of the calcaneus and attaches to the heads of the metatarsal bones. A heel spur occurs on the anterior surface of the calcaneal tuberosity at the site of attachment of the plantar aponeurosis.

When walking, when the heel comes off, the fascia is pulled. When wearing uncomfortable shoes, flat feet, sports overload, this tension can become excessive and lead to chronic inflammation of the fascia attachment to the calcaneus. When the foot is overloaded, a slow stretching of the plantar aponeurosis occurs, detachment from the place of attachment to the heel and gradual calcification of the place of attachment.

This process is slow, dragging on for years. Subsequently, calcium salts are deposited in this place, and the picture shows a horizontal “spike” up to 2 cm long (calcaneal spur). Thus, the heel spur is the outcome, not the cause of the disease. When the heel begins to hurt due to inflammation of the tendon, the bone “thorn” on the radiograph is not yet visible. The presence or absence of a heel spur does not affect the diagnosis and treatment of heel pain. Many people have heel spurs on x-rays and have never had heel pain. When this osteophyte matures completely, it does not hurt.

So, heel pain should never be blamed on the “notorious” heel spur. What then can be the cause of heel pain ? And many other serious diseases debut or are manifested by pain in the heel. Only a specialist can make an accurate diagnosis and prescribe competent treatment. With heel pain, the main thing is not to miss a serious disease that can lead to surgery and disability.

Risk factors for heel pain are overweight, high-heeled shoes, flat feet, chronic foot overload, sports injuries, heel bruising when jumping from a height. In this article, we will not consider traumatic causes of heel pain. Fractures, dislocations, bruises, sprains require treatment by a traumatologist.

Heel pain: symptoms. Pain in the heel brings great suffering with every step. The clinical picture largely depends on the disease that caused the pain in the heel. Pain in the heel can be aching, dull, sharp, burning, shooting. More often pain in the heel bothers when walking. Sometimes pain occurs even at rest, at night, disturbing sleep. The nature of heel pain, as well as the cause that caused it, can be different.

Diseases that cause pain in the heel.

Plantar (plantar) fasciitis or “heel spur “. The main symptom of the disease is acute pain under the heel, especially pronounced during the first steps after sleep or a long rest. The pain can be so severe that during the first minutes, patients move around on the edge of the foot or fingers, avoiding stepping on the heel. After a few steps, the pain in the heel noticeably decreases. On palpation, the middle of the heel from the plantar side is sharply painful. If such a painful point is absent, then the diagnosis is in doubt.

Achilles bursitis (inflammation of the Achilles tendon and its bags). The Achilles (calcaneal) tendon attaches the gastrocnemius and soleus muscles to the calcaneal tuberosity. The cause of heel pain is long-term chronic overexertion or acute situational overload of the calf muscle, anabolic steroids, or frequent blockades with corticosteroids. Achilles bursitis occurs predominantly in athletes, ballet dancers and dancers, often accompanied by tears or ruptures of the tendon.

Pain is localized above the heel and on the back of the leg, accompanied by lameness and inability to stand on the toes. Clinically, there is tenderness, swelling, and redness on both sides of the Achilles tendon. The calf muscles are tense and painful. Pain in the heel and calf worse in the morning, the patient can hardly lean on the affected leg when getting up.

Posterior Achilles tendon bursitis often develops as a result of excessive friction and pressure from an uncomfortable shoe heel. But it can also be an early symptom of rheumatoid arthritis. Such bursitis is clearly visible above the calcaneus, as a round, painless subcutaneous formation.

Ankylosing spondylitis, reactive arthritis can debut with “spontaneous” heel pain in young people even before the appearance of typical clinical manifestations of the underlying disease.

Reactive arthritis in infections (chlamydia, ureaplasmosis) has characteristic signs: pain in the heels bothers not only when walking, but also at rest, increases at night. In addition to pain in the heels, other joints, eyes become inflamed, urethritis appears (Reiter’s disease).

Radiculopathy S 1 root occurs when a herniated L5-S1 disc is prolapsed. When the S1 root is compressed, the pain spreads along the back of the leg below the knee to the heel. The Achilles reflex falls out, the sensitivity in the heel area is disturbed.

Osteochondropathy in the zone of ossification of the calcaneal tuber occurs in adolescents 12-15 years old. A delay in the restructuring of this zone during growth causes severe pain in the heel. The disease is treated conservatively, the effect is weak. In most cases, heel pain goes away on its own after the child stops growing. In adults, this pathology does not occur.
Very rarely pain in the heel occurs with tumors, osteomyelitis, tuberculosis.

When should I see a doctor urgently?

• for very severe heel pain;
• heel pain increases with time;
• for redness, swelling of the heel area;
• with an increase in body temperature.


Which doctor should I contact if my heel hurts? In acute trauma, consultation with a traumatologist or surgeon is necessary. In other cases, you should visit a therapist who will prescribe an examination and, if necessary, refer you for a consultation with a rheumatologist, orthopedist or neurologist or other specialist.

Diagnostics for heel pain.
Complete blood count (leukocytes, ESR) confirms inflammatory processes in the body. The higher the white blood cells and the ESR (erythrocyte sedimentation rate), the greater the inflammation. An increase in ESR in combination with nocturnal pain indicates a rheumatic disease.

Blood test for rheumatic tests. In rheumatic diseases, the level of CRP is sharply increased. Negative rheumatic tests rule out rheumatic causes of heel pain. A positive rheumatoid factor confirms the association of heel pain with rheumatoid arthritis.

Blood test for antibodies to chlamydia and ureaplasma, scraping from the urethra allows to exclude reactive arthritis in heel pain.

X-ray displays bone changes in the heel region, excludes traumatic causes of pain in the heel, tumors, osteomyelitis, bone tuberculosis.

Heel MRI helps to detect the earliest changes in cartilage, tendons, ligaments. MRI of the lumbosacral spine confirms the presence of a disc herniation in radiculopathy.

Treatment for heel pain depends on the cause. Different diseases require different approaches to treatment. To reduce pain in the heel, there are also general rules:

• limit the time spent on your feet;
• rest the lower limb for 2-3 weeks;
• give up high heels;
• reduce weight in obesity;
• use arch supports, insoles or orthopedic shoes;
• exercise therapy for the feet.

Non-steroidal anti-inflammatory drugs (NSAIDs) help relieve inflammation. Prolonged uncontrolled use can cause stomach or heart problems. Be careful when self-medicating.

Achilles bursitis for external use can be used compresses with dimexide or medical bile, ointments with NSAIDs. Care should be taken with warming ointments and compresses. In case of injuries, edema, warming procedures are contraindicated. In this situation, it is better to apply an ice pack wrapped in a towel to the sore spot for 10-15 minutes.

Showing physiotherapy, mud therapy. When the tendon is torn, surgical treatment is required. With a “heel spur” ointments, compresses, laser therapy, acupuncture and physiotherapy have no effect. Shock wave therapy relieves pain well.

In case of inflammation, acute pain in the heel is quickly relieved by therapeutic blockades with corticosteroids directly to the source of pain. But they should be carried out by competent doctors strictly according to the indications of no more than 3 procedures at one point. Frequent administration of corticosteroids contributes to tendon tearing, so it is dangerous to abuse this method!

Rheumatoid arthritis should be treated by a rheumatologist. A constant intake of specific basic drugs, non-steroidal or steroidal anti-inflammatory drugs is shown. With radiculopathy, treatment is carried out by a competent neurologist.

In urogenital infections, antibiotics are prescribed under the supervision of a dermatovenereologist. Tumors, tuberculosis, osteomyelitis require specific treatment from specialized specialists.

In my hands, the best treatment for heel pain is interstitial electrical stimulation. Only 2-3 VTES procedures relieve the patient from heel pain for several years, or even for life.

Heel pain: types of pain, location

Severe pain in the heel during the onset is characterized by unpleasant sensations that develop as a result of pathological problems in this area. Pain can be of varying intensity, strength and are provoked by the support on the heel. The reasons for this phenomenon are varied.

General information

Understanding the causes of heel pain is sometimes very difficult, since this symptom accompanies a large number of diseases. Therefore, many attribute discomfort to fatigue, uncomfortable shoes. Most often, women face this problem. However, an insidious disease can hide behind a seemingly harmless symptom.

Varieties of pathology

Pain in the heel is divided by etiological factors, duration, time of occurrence. The reasons can be physiological and pathological. The first option includes inflammation, pinched nerves, systemic tissue damage. Physiological are overwork, overstrain of the foot, uncomfortable shoes, prolonged stay on the legs, overweight.

By duration:

Name	Description
Acute	They are short-term, develop after injuries. Disturbed for a short period of time, pass on their own
Chronic	They are periodic, permanent, in most cases associated with pathological processes.

According to the time of development, pain can be disturbing at any time of the day, develop when stepping on the heel, when the weather changes, with prolonged movement.

Causes of disease

Pathological etiological factors can be chronic inflammatory processes in the joints, spine, rheumatoid arthritis, gout. The causes are such infections as:

• osteomyelitis of the calcaneus;
• bone tuberculosis with necrotic processes;
• reactive arthritis, developing urogenital, intestinal infections.

Sharp, aching pain in the heel can develop due to heel spurs, bursitis, Haglund-Schinz disease, Achilles tendonitis.

Important! The cause may be trauma, sprains, tendon ruptures, bruises, fractures, vascular and dermatological problems. Sometimes the problem is caused by mental, nervous disorders.

Symptoms of disease

If we are talking about the physiological causes of the pathology, then there is a feeling of heaviness in the legs, pain is burning, sharp, aching, swelling of the lower leg and foot appears.

In traumatic injuries, the clinical picture depends on the type of injury.

Bruises

Appears after unsuccessful jumps, is characterized by acute pain, which gradually subsides, intensifies when walking, uncomfortable position of the leg. As a result, the patient is forced to walk on tiptoe. Sometimes there are moderate swelling, bruising, which disappear with time.

Tendon rupture

The pain is sudden, sharp, localized on the back of the heel. Sometimes you can hear the crackling of the torn fibers of the Achilles tendon. Rapidly develops swelling and failure at the site of injury. With severe damage, the patient is not able to raise the heel. If the degree of damage is mild, then movements are partially limited due to pain.

Fracture

It is characterized by unbearable pain in the calcaneus, which increases with the development of edema. Patients note that the pain is throbbing, the heel becomes large, swollen, cyanotic. Palpation is painful and impossible, movements are limited.

Pathological fractures are more common in the elderly. The causes are osteoporosis, changes in bone strength. The pain is not intense, bursting, aching, it hurts to step on the leg, swelling, bruising develops. Palpation is painful, with a change in the position of the injured limb, pain occurs.

Inflammation of ligaments, tendons

With an increase in the volume of the Achilles tendon, patients report aching pains, which subsequently increase, become longer. The problem most often occurs in athletes.

Haglund’s deformity is recorded in young women up to 30 years of age. Patients note the appearance of burning, sharp pains after a long walk or during it.

A heel spur causes a lot of trouble. In severe cases, due to pain, patients are forced to use crutches.

Infectious processes

Exogenous osteomyelitis is accompanied by an increase in body temperature, deterioration of the general condition, tearing, shooting, bursting, pulling pains. Pus, fistulas may form.

Hematogenous osteomyelitis is very rare in children. The onset of the pathological process is violent with fever. Children try to keep their legs at rest, as any movement is accompanied by pain that makes you want to scream. After a couple of days, swelling and redness will be noticeable.

If your heel bone hurts, the pain is unbearable, you want to climb the wall, you need to urgently consult a doctor and get advice. It is impossible to delay in this state, the risk of developing serious complications is high.

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Which doctors to contact

If the heel on the legs hurts, it is recommended to consult a surgeon, orthopedist, traumatologist. In certain cases, it may be necessary to consult an infectious disease specialist and other doctors. The specialty depends on the causes of the pathology.

Diagnosis

The diagnosis is made comprehensively on the basis of the medical history, anamnesis, examination, laboratory tests, and instrumental examination. To clarify the diagnosis, you may need studies such as:

1. MRI, CT. They are resorted to if it was not possible to identify the cause of the pathological condition or it is necessary to clarify the location of the fragments in fractures.
2. Radiography. Pictures are taken of the calcaneus or foot. The method allows you to identify a fracture, the presence of fragments, necrotic areas.
3. Laboratory methods. Necessary for infectious processes, intoxication.

If necessary, doctors can prescribe BAK, KLA, bakposev, tests for tumor markers, puncture of the synovial fluid.

What can you do

If you feel that you are shooting at the heel, the bone on the heel has become more mobile, acute pain has appeared, movements are limited or impossible, there is a burning sensation in the heel – you need to call an ambulance. It is not recommended to apply heat in cases of incomprehensible pain, inflammatory, purulent processes. With fractures, it is important to give rest to the injured limb. In cases of physiological pain – to establish the cause, buy special shoes, orthopedic insoles.

Important! Do not self-medicate, even for wearing orthopedic shoes, insoles, you need the opinion of an orthopedic doctor. Do not try to treat the disease with traditional medicine.

Treatment

First aid consists in applying a splint, applying ice to the site of a bruise, injury. In inflammatory processes, drugs prescribed by specialists are taken. In cases of deterioration of health, sharp pains, you should immediately consult a doctor.

Therapy can be conservative and surgical.

Conservative treatment

Pathology can be cured with a combination of drug therapy and non-drug therapy. First, the load is removed from the diseased limb, drugs are prescribed in the form of NSAIDs, antibiotics, anti-inflammatory, antispasmodics. If necessary, wounds are treated with antiseptics, dressings, plaster are applied.

Surgery

In case of injuries, doctors resort to osteosynthesis, suturing the Achilles tendon. If there is an infectious process, then abscesses, fistulas are opened, washed, drained, sequestrectomy is performed. With trophic ulcers, shunting, skin grafting, phlebectomy are indicated.

If you have been prescribed a treatment, but you doubt its fidelity, sign up for an online consultation. Our doctors in the format of video, audio, correspondence will clarify the symptoms, advise on the prescribed treatment, select analogues of drugs, check the prescribed drugs in the list of rejected ones, check the indications for use, contraindications, side effects.

FAQ

Why does my left foot hurt after running?

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Perhaps the reason lies in uncomfortable shoes, improper running technique.