Stomp Out Heel Pain
By Harvey Danciger, DPM

Heel and arch pain have become more prevalent and are common reasons why patients come to see me for care.  There are many different causes for heel pain, so prompt and proper diagnosis is crucial.  The sooner the problem is diagnosed and treated, the quicker the recovery to get back to normal.

Some of the symptoms of heel pain are pain in the back or the bottom of the heel, pain that gets worse as the day goes on, pain that worsens on arising and pain that increases over time.  Stiffness and difficulty walking are additional signs.  The most common causes of heel pain on the bottom of the foot are plantar fasciitis, heel spurs, and tarsal tunnel syndrome.  For posterior, (back of the heel) heel pain, causes can be Achilles tendonitis, heel bursitis and heel bumps.  Injury, fractures, tumors and arthritis are also causes of both types of heel pain.

Plantar fasciitis is the most common cause of heel pain on the bottom of the foot.  It is an inflammation in the plantar fascia, the band of tissue that goes from the heel to the ball of the foot.  The pain is usually a sharp, stabbing pain on the inside of the bottom of the heel.  It seems to be more painful upon first standing in the morning or after periods of rest.  Many people think that the problem will go away, but in fact, it often gets worse.  The more you are on your feet, the more strain develops, causing resultant pain and degeneration.

Heel spurs can be found in many people with heel pain, but they are rarely the source of the pain.  Heel spurs form in reaction to the tension caused by tight plantar fascia.  Spurs are bone that grows on the underside of the heel.  The size of the spur has no correlation to the degree of pain one feels.

Tarsal tunnel syndrome is the counterpart of carpal tunnel syndrome in the wrist.  If the nerve becomes compressed or is squeezed in the canal, symptoms can ensue.  They include pain, numbness over the bottom of the foot or burning or tingling in this area.  The nerve which is affected is the posterior tibial nerve.  It can send branches off to the side and underneath the heel bone, which become entrapped and can complicate the problem.

Pain in the back of the heel can be a result of Achilles tendonitis, a common overuse injury and inflammation of the tendon.  The Achilles tendon attaches to the heel bone in the back and symptoms can include stiffness, tenderness, enlargement, swelling and pain when the tendon is squeezed.  Heel bursitis can also develop and be confused with Achilles tendonitis.

Another cause of pain behind the heel is known as Haglund’s deformity, which is a heel bump or enlargement at the back of the heel bone.  It has also been called a pump bump.  This can cause difficulty in wearing shoes because of the pressure and irritation from the bone.  The enlarged bone can put pressure on the Achilles tendon, causing inflammation and a fluid filled sac to develop, which can become inflamed and painful.

Sever’s disease is the most common cause of heel pain in children.  It is a disturbance and inflammation of the growth plate in the back of the heel.  Activities usually worsen the condition and pain.  Pain is often noted when the heel bone is squeezed.  Many times the onset is in children between the ages of 7-13 and especially when they become active in sports.

Injuries are also a cause of heel pain and can result in fractures and stress-type fractures of the heel.  Ligaments can be torn and soft tissue injuries can result in pain and swelling.  Tumors are less frequent, but can be present with pain in the area.

Most heel pain can be treated conservatively, without surgery, once the diagnosis is made.  Most heel problems respond faster and heal quicker the sooner treatment begins after the onset of symptoms.  Don’t let heel pain get you down.  Feet should not hurt, any symptoms of pain are not normal.

Dr. Danciger is a Podiatrist practicing in Palm Desert.  His practice provides care for infants thru geriatrics for all foot and ankle problems, including injuries, diseases, medicine and surgery.  He is Board Certified in Foot and Ankle Surgery.  Please visit his website at www.CoachellaValleyPodiatrist.com or call (760) 568-0108.