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Heel Pain

What causes heel pain?

Heel pain can be caused by a variety of different conditions ranging from mild to severe. Because heel pain can be a result of many different factors, it is important to have the area examined by a podiatrist who can properly diagnose the problem and determine the underlying source of the pain.

Causes of heel pain include plantar fasciitis, heel spurs, tarsal tunnel syndrome, stress fractures and tendonitis. In rare cases a cyst may also cause heel pain.

What is Plantar Fasciitis?

Plantar Fasciitis is a pain that is felt when the connective tissue band known as the plantar fascia is placed under so much stress that it begins to micro tear off its attachment to the heel. This pain feels worse when you put weight on your foot after long periods of rest. Typically patients will say that their foot feels the worst when they step out of bed in the morning. Patients also note that it hurts badly when they get up after sitting or driving.

Many times a heel spur will be seen with plantar fasciitis but it is not the cause of the problem, it is only a sign of long-term changes caused by chronic plantar fasciitis. Treatment of heal pain by surgical removal of the spur is no longer considered a good option.

What are treatments for Plantar Fasciitis?

Plantar fasciitis is treated with athletic strapping, physical therapy, corticosteroid injection, and orthotic control and as a last resort, surgery. It is a problem that only a lower extremities specialist will have the diagnostic acumen, techniques and materials for successful long-term treatment.

What is Tarsal Tunnel Syndrome?

Tarsal Tunnel syndrome presents to the patient as pain on the plantar/bottom surface of the foot. This pain can be sharp pain, a dull pain, a burning pain, an electrical shock type pain, pins and needles or it can feel like you're constantly striking your funny bone when you put weight on your foot.

Tarsal Tunnel syndrome is caused by irritation and entrapment of a large nerve (the Posterior Tibial nerve) on the medial or inner portion of the ankle/heel area.

What are treatments of Tarsal Tunnel Syndrome?

Treatment of Tarsal Tunnel syndrome is by physical therapy, injections of corticosteroids, orthotic control, and immobilization of the ankle joint and as a last resort surgery.

What are Stress Fractures?

A stress fracture is a break in a bone that does not go all the way through the bone. The break is so small that it is less than the wavelength of an x-ray and therefore will not be seen on x-ray for a week to 10 days after the injury. Emergency room staff and family physicians that do not have the experience to diagnose a fracture that is not visible on x-ray often miss it. Despite the small size of the stress fracture these can be very painful and they require treatment like any fracture.

The most common stress fractures are of the metatarsals, which are the long bones in your feet just before the toes. Stress fractures can also occur in the navicular bone as well as the heel. These last two fractures are much less common.

Stress fractures occur without significant trauma. They are usually caused by repetitive activities such as walking or an athletic activity that you have not done for a long time. Typically the pain will begin when you wake the next morning. The area surrounding the fracture will be swollen, warm and possibly red.

What are treatments for Stress Fractures?

Casting, immobilizing shoe gear, rest, ice and physical therapy, will treat the fracture.

What is Posterior Heel Pain and Tendonitis?

Heel pain that occurs at the back of the heel (the posterior aspect) is usually the result of Achilles tendonitis. This is the inflammation of the Achilles tendon and the retro-calcaneal bursa at the back of the heel bone (the calcaneus).

A more severe pain in that area may be a rupture or tear of the achilles tendon or the plantaris tendon. The pain from a plantaris tendon rupture feels as if one had been struck in the back of the calf with a BB pellet. The pain from an achilles tendon rupture has been described as, "being hit in the back of the calf by a baseball bat."

This kind of pain is very common in people who participate in racquet sports. This pain often begins after the person has taken a step backwards to get ready to strike the ball. People experiencing this type of pain should immediately stop activity and aggressively apply ice to the area. They should seek an experienced lower extremity specialist as soon as possible.

What are treatments for Posterior Heel Pain and Tendonitis?

These problems require treatment by a trained lower extremity specialist using physical therapy, immobilization, and corticosteroid injection and as a last resort surgery.

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