One of the most common foot problem I treat is heel pain. There are several causes of pain under and around the heel that will lead a person into my podiatry office here in Tuscaloosa. The top 3 causes of heel pain that I see occurring under the foot would be the following.
PLANTAR FASCIITIS (Heel Spur Syndrome)
Plantar Fasciitis is essentially inflammation of the plantar fascia ligament which runs from the ball of the foot and attaches to the bottom of the heel bone. When excessive tension is applied to this ligament, small tears in the tissue can elicit an inflammatory reaction anywhere along the plantar fascia. The plantar fascia ligament consists of three bands that attach to the heel bone: medial (inside border of the heel), central (middle of the heel), and lateral (outside border of the heel). Many times an x-ray will also show a heel spur where the ligament attaches to the heel. Majority of cases, the pain is not caused by the spur but by the surrounding inflammation. The most common site for plantar fasciitis pain is medially under the heel near the arch. The pain is mostly felt standing on the feet after a period of rest often times occurring with the first few steps in the morning. Initially, this pain can ease up after walking but can progress to persistent pain throughout the day. Common causes of plantar fasciitis are increase body mass, prolong time standing, sudden increase in activity on the feet, or trauma caused by excessive flexion of the foot. Successful treatment is usually achieved when the condition is addressed within the first 3-6 months. Plantar fasciitis can be a chronic problem if left untreated. There are a number of conservative treatments that can be done to avoid surgery. My initial treatment typically includes a course of anti-inflammatory medication, foot strappings, and stretching exercises. This usually resolves the pain in acute cases or decrease the pain by as much as 50% before incorporating other treatments such as cortisone injections, night splint brace, custom foot orthotics, foot/ankle walking brace, or physical therapy.
FAT PAD ATROPHY
The natural fat pad which cushions the bottom of the heel bone can thin out (atrophy) as we age. It can also be pushed into the outside borders of the heel from excessive pressure on the heel due to increase body mass and prolong time standing. When there is not enough fat tissue to pad underneath the heel bone, a dull achy pain can be felt directly in the center of the heel. Patients often describe this heel pain as having a “stone bruise.” The pain is usually worse toward the end of the day after being on the feet. Treatment for heel pain due to fat pad atrophy may include shoe inserts, padding, footwear modifications, and heel devices that can help redistribute the fat back underneath the heel.
TARSAL TUNNEL SYNDROME
Similar to what happens in the wrist (carpal tunnel syndrome), the tarsal tunnel is a narrow space which runs along the inside of the ankle. Inside the tunnel is a nerve called the tibial nerve which can get squeezed causing a burning shooting pain that can extend from the ankle to the heel. A branch of this nerve called the medial calcaneal nerve carries sensations to the bottom of the heel. Symptoms are usually worse toward the end of the day and when pressure is applied to the area. Compression of this nerve can be due to inflammation of other structures in or around the tunnel, abnormal structures in the tunnel, or poor foot biomechanics (usually over-pronation) particularly in flat feet. Treatment for tarsal tunnel syndrome may include anti-inflammatory medication, local anesthetic or steroid injections, foot orthotics, physical therapy, and immobilization with ankle brace or cast. Sometimes surgery is necessary to relieve the cause of the nerve compression.
If you are suffering from heel pain, I encourage you to schedule a podiatry visit as soon as possible. Early treatment of foot pain brings about a more successful outcome. Diagnosing the cause of your heel pain will involve taking a complete history of the condition along with a physical foot exam. Digital x-rays are taken in the office which you will have an opportunity to view and ask questions. Relatively few cases of heel pain require surgery or more advance treatment. My goal as your podiatrist would be to treat your foot pain as conservative as possible. With the foot care and knowledge you need, we can help treat your heel pain and prevent recurrence.
If you live in the Tuscaloosa area and need a podiatrist to help heal your heel pain, call my office at 205-409-0175 to schedule an appointment.
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