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What is causing my heel pain?

imageHeel pain can be caused by a number of reasons, the most common include:
Heel spurs and Plantar Fasciitis
Tendonitis, bursitis or periostitis
Osteochondritis or Severs Disease
Arthritis
Callus and corns (hard skin) or warts (Verrucae)
Fat pad contusion
Fracture including stress fracture
Neuritis, nerve impingement or Tarsal Tunnel Syndrome
Haglund’s Deformity, heel bumps or ‘pump bumps’
Bone cyst
Heel bruises

Heel pain has many causes, usually the result of faulty biomechanics (abnormalities in the way we stand, walk and run). This can place too much stress on the heel bone and the soft tissues attached to it. The stress may also result from injury, or a bruise incurred while walking, running or jumping on hard surfaces; wearing poorly constructed footwear; or being overweight.  Systemic diseases such as arthritis and diabetes can also contribute to heel pain.

Heel Spur Syndrome
This is a very common condition, usually occurring in the over-forties age group. There are no visible features on the heel but a deep localised painful spot can be found in the middle or around the sole of the heel. Although the pain is often associated with a spur of bone sticking out of the heel bone (true heel spur), people can have heel spurs without any pain and some have the symptoms without the spurs being present.
Both heel pain and heel spurs are frequently associated with an inflammation of the long band of tissue that connects the heel and the ball of the foot. The inflammation of this arch area is called Plantar Fascitiis.
The pain is often most severe on arising after sleeping or sitting. The heels are also very sore after standing for a long time.
Resting usually provides only temporary relief. When resuming walking, particularly after a night’s sleep, there may be a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a temporary sense of relief. The pain often returns after prolonged rest or extensive walking.

Causes
For many years it was believed to be primarily the result of an overuse of the plantar fascia, leading to inflammation of the attachment to the calcaneus (heel bone). It is now thought to be associated with degenerative changes. Heel pain sometimes results from excessive pronation. One study has shown that people that are more flexible are more likely to get Heel Spur Syndrome and Plantar Fasciitis.
Treatment

imageIn the short term the application of padding and/or strapping is often used to alter the direction of stretch of the plantar fascia.
Avoid going barefoot as more strain is put on the plantar fascia without shoes.
The use of correct footwear that provides good support is important - even a slightly raised heel may reduce the stress on the plantar fascia.
Conservative treatment may include stretching exercises. Exercises that stretch out the plantar fascia, calf muscles and achilles tendon are thought by some to help reduce symptoms. Pain with the first steps of the day can be markedly reduced by stretching the plantar fascia and achilles tendon before getting out of bed.

Medications.
To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit as these medications will unfortunately delay healing. For this reason it is not recommended without consultation with a health professional first.
Dexamethasone 0.4 % or acetic acid 5% delivered by ionophoresis combined with low dye strapping and calf stretching has been shown to provide short term pain relief and increased function.
Local injection of corticosteroids often gives temporary or permanent relief, but may be painful. Recurrence rates may be lower if the injection is performed under ultrasound guidance. Repeated steroid injections may result in rupture of the plantar fascia and while this may actually improve pain initially, it has deleterious long-term consequences.

Weight Loss.
Extra weight puts extra stress on the heels and plantar fascia.

Orthotic Therapy.
In the long term, special insoles (orthotic therapy) may be prescribed to help the feet to function more effectively, thereby reducing strain on the heel and making any recurrence less likely.  It will effectively treat the majority of heel and arch pain without the need for surgery. This is one of the most effective treatments for this condition as it works towards treating the abnormal foot function that has caused the initial problem. Orthotics are the only non-surgical therapy to have been supported by studies rated by the Center for Evidence-Based Medicine as being of high quality.

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