Heel Pain


One of the most common reasons to present in my office is for heel pain. Heel pain comes in two basic types. Pain at the back of the heel where the Achilles tendon attaches to the heel bone, and pain at the bottom of the heel where you stand, which is the origin of the plantar fascia. Most people come in complaining of a heel spur as the source of the pain, however it is rarely the spur itself that is causing the problem. The pain truly originates from the structures that attach to the heel bone, and often there is no spur associated with the pain. These two heel pains are most commonly referred to as insertional Achilles tendonitis and plantar fasciitis.

The underlying reason for developing either of these problems if the same. It all originates from over tightness and over pull of the calf muscle (gastrocnemius). Constant overpull of this muscle on the Achilles tendon, heel bone (calcaneus) and then plantar fascia cause inflammation.  The classic complaint is a sharp stabbing pain that goes directly into the heel upon first stepping on the foot, either after first waking up, or getting up from being in the seated position. This is called “start-up” pain. Once a few steps are taken, the pain often will subside and/or diminish, until the person sits again for a period of time.  Then when you get up again, the pain strikes back.

Fixing this problem is rarely a surgical problem, and as you can imagine, fixing it is centered around treating the underlying problem. That culprit is most often the over tightened calf muscle (gastrocnemius).  Spending a good 10-15 minutes a day stretching your calf can go a long way at relieving the overpull on the Achilles tendon and the plantar fascia. Avoid calf strengthening exercises. Freezing a water bottle, and then rolling your foot on it is a great way to not only stretch the plantar fascia, but also ice the inflamed tissues. While shoe inserts (orthotics) are not necessary, I will often recommend a gel heel cup that helps soften the impact when you stand on your heel and plantar fascia, and also elevates the heel a small amount which in turn takes some tension of the Achilles tendon, and can give a significant amount of pain relief. Pain that persists longer than 3-4 weeks should prompt a visit to your primary care or orthopedist for further evaluation with an examination and x-rays. Often the next treatment is physical therapy, and if this is not successful, a cortisone shot can be helpful.

The good news is that surgery is rarely recommended. Patience and consistent stretching leads to a successful outcome in the majority of patients. Oh, and try not to walk too much barefoot…thank goodness its freezing and in the dead of winter, so keep your feet snug and in some well cushioned shoe wear as much as possible…it will go a long way.

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