Some questions answered
Pain in the heel can be caused by many things. The commonest cause is plantar fasciitis . However other causes include:
The function of the heel in walking is to absorb the shock of your foot striking the ground as it is put down and to start springing you forward on the next step. It contains a strong bone (the calcaneum). Under the bone are a large number of small pockets of fat in strong elastic linings, which absorb much of the shock (fat pads). The heel is attached to the front of the foot by a number of strong ligaments which run between the front part of the calcaneum and various other parts of the foot. The strongest ligament is the plantar fascia, which attaches the heel to the toes and helps to balance the various parts of the foot as you walk. It therefore takes a lot of stress as you walk.
In some people the plantar fascia becomes painful and inflamed. This usually happens where it is attached to the heel bone, although sometimes it happens in the mid-part of the foot. This condition is called plantar fasciitis. There are a number of common causes:
These “heel spurs” are commoner in people with plantar fasciitis, but they can be found in people with no heel pain. The heel spur forms in response to injury. The body tends to overproduce calcium to repair the defect due to the injury . Since Plantar Fasciitis causes pain and swelling to the tissue along the bottom of the foot by pulling on the heel where it connects, this is where heel spurs tend to form in response to that injury. The spur is not itself the cause of the pain.
You can try to avoid the things that cause heel pain to start:
If your heel pain is affecting your normal activities and not getting better with simple self-treatment you should visit a Foot and Ankle surgeon.
Some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray will show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a scan may be used to help spot arthritis or a stress fracture.
As heel pain is basically a stress problem in the tissues of the heel, the main treatment is to reduce stress.
The simple measures above will help the majority of people with heel pain. If the pain continues, a splint to wear on your ankle at night to prevent your Achilles tendon tightening up while you are asleep is often very effective in improving the severe pain that many people get first thing in the morning and breaking the cycle of pain. Your orthopaedic foot and ankle surgeon may inject some steroid into the attachment of the plantar fascia to damp down the inflammation. These measures will reduce the pain in most people who are not helped by simple treatment. Maximum of only 1 injection should be tried.
If you still have pain persist then further investigation should be done. If no other medical problem or cause of stress in your heel is found, a number of other treatments can be tried:
It is rare to need an operation for heel pain. It is offered only if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear.
The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. This sort of surgery can be done through a key hole surgery with a skin cut about 1cm long on the inner side and outer side of your heel respectively. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.
As you will have seen from reading the section above “I’ve been told my pain is caused by a bone spur”, the pain is not caused by the spur. Rather, both the pain and the spur are caused by inflammation in the plantar fascia. Simple removal of the spur has been known to be ineffective in relieving the pain since the 1960s.
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