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Your Health Blog

    Understanding & Treating Heel Pain

    Brandt Dodson, DPM Deaconess Clinic Podiatry 09/11/2018

    In my 30 years of practicing podiatry, I’ve cared for thousands of people with heel pain. It’s actually one of the most common complaints I hear in my office.

    While every patient’s pain is different, heel pain can really be divided into two categories – traumatic and mechanical issues.
     
    Trauma is pain caused by an injury, either sudden (an accident, something falling on the foot, etc.) or repetitive. Stress fractures, such as those found in runners, are an example of a repetitive traumatic injury.
     
    Pain stemming from mechanical issues means some part of the foot isn’t functioning properly.
     
    For the purposes of this article, I want to concentrate on the two most common examples of mechanical foot pain: plantar fasciitis and Achilles tendonitis.
     
    Plantar Fasciitis
    Plantar means “bottom of the foot” and fascia is a ligament that extends from the bottom of the heel to the ball of the foot. It provides stability.
     
    When this ligament is abnormally pulled or stretched, it will often partially tear. The pain comes from the damaged ligament and the repetitive “pulling” on it when people walk.
     
    When you’re non-weight-bearing (sitting or reclined and not putting any body weight on the foot), the ligament will tighten up. This is why the first steps you take in the morning or following periods of rest (such as standing up after sitting for a while) hurt so much.
     
    Diagnosing and Treating Plantar Fasciitis
    A plantar fasciitis diagnosis is based on a physical exam and the patient’s reported symptoms and history.

    When the diagnosis is confirmed, there are a variety of treatment options to consider.

    • Stretching. Before getting up each morning and at the end of the day, the foot should be stretched and exercised.
    • Proper shoe selection. Supportive shoes with stiff soles are always best for people with plantar fasciitis. Flexible soled shoes, as well as shoes without backs, should be avoided.
    • Anti-inflammatories, such as ibuprofen and naproxen, can be helpful. 
     If these aren’t effective, see a podiatrist. You may benefit from:
    • Physical therapy
    • Taping
    • Immobilization with a splint or brace
    • Orthotics for long-term control
    90%+ of all people with plantar fasciitis will respond to some combination of these treatments.  VERY few people need surgery, although it can be an option after trying all other treatments with no pain relief.
     
    Achilles Tendonitis
    The Achilles tendon is a tendon, different from the fascia, which is a ligament. The Achilles tendon is located behind the heel, running up the back of the heel to connect the calf muscle to the heel. If the tendon is tight, it exerts a pulling force and can occasionally irritate the plantar fascia, since the two are connected.
     
    The symptoms of Achilles tendonitis are very similar to plantar fasciitis, but with Achilles, the pain centers on the back of the heel rather than on the bottom of the foot.
     
    Diagnosing and Treating Achilles Tendonitis
    An Achilles tendonitis diagnosis is also based on a physical exam and the patient’s reported symptoms and history. Once a diagnosis is confirmed, treatments are very similar to plantar fasciitis, with a few differences. 
    • Stretching. Before getting up each morning and at the end of the day, the foot should be stretched and exercised.
    • Proper shoe selection. Supportive shoes with a bit of an elevated heel are always best for people with Achilles tendonitis. Flat soled shoes, as well as shoes without backs, should be avoided.
    • Anti-inflammatories, such as ibuprofen and naproxen, can be helpful. 
    If these aren’t effective, see a podiatrist. You may benefit from:
    • Physical therapy
    • Immobilization with a splint or brace
    • Heel lifts for long-term control
    Risk Factors for Plantar Fasciitis and Achilles Tendonitis
    • Age. The older you get, the more likely you are to have this issue. Given enough time, almost everyone will develop one or both of these issues at some point in their life.
    • Activity level. Runners, basketball players, people involved in jarring/explosive movements, etc. are prone to developing this issue. Weekend warriors, or those who suddenly increase their activity, can also be more likely to develop either problem.
    • People who stand on concrete for long spans of time, such as factory workers.
    • Those who climb ladders, such as electricians and construction workers.
    • Family history of this type of foot problem.
    • Being overweight can contribute to these issues, due to putting more stress and pressure on the foot overall.
    Risk Reduction
    It’s not always possible to prevent plantar fasciitis or Achilles tendonitis, but the risk can be lessened by following these tips:
    • Stretching before and after activities such as yard work, running, other athletic activities, or unusual amounts of walking (such as on vacation).
    • Wearing appropriate shoes for activities.
    • Moderate activities. Gradually increase activity if you want to exercise more. Going from no activity to a lot at once is going to set you up for problems.
    • If needed, work on getting to a healthier weight. It will protect your feet and all other joints as well.
    Orthotics
    A true orthotic is a device constructed to a corrected model of an individual person’s foot. Most orthotics are rigid in nature to help control and/or correct the abnormal function of the foot. However, when working properly, the orthotic will not feel hard—it will feel supportive.

    Orthotics are designed to be worn daily, for long periods of time. They don’t “fix” your foot—they help the foot function properly. (Eyeglasses are a similar example: they don’t fix what’s wrong with your vision, they simply correct it.)
     
    Here at Deaconess Clinic, we have advanced orthotic-development technology. A laser scanner is used initially to capture a model of each foot. We then use a computerized digital system to make corrections to the structure to develop an orthotic that will help bring the foot into the closest-to-normal alignment and positioning possible. The closer to normal the foot performs the less structural pain results.
     
    In conclusion, heel pain isn't something you have to live with.  Try some of the suggestions above first, and if you still are suffering, please schedule an appointment online now!  
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