Cronic heel pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

The proper spelling is chronic but no matter. Heel pain can be annoying.

The calcaneus (heel bone) is the largest of the 26 bones in the human foot. Heel pain can occur in the front, back, or bottom of the heel.

A common cause of heel pain is the plantar fasciitis.

This is a condition where there is irritation and microtears of the connective tissue band that connects the bottom of the heel to the base of the toes. This occurs as a result of several possible factors including biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.

The condition is often accompanied by inflammation, pain, and possibly the growth of a bone spur where it attaches to the calcaneus.

The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area.

Resting provides temporary relief. Resumption of walking, particularly after sleep, causes a sudden stretching of the fascia band, which then stretches and pulls on the heel. With continued walking, the heel pain may lessen. The pain returns after prolonged rest or extensive walking.

Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to absorb shock with normal walking and running.

Excessive pronation—excessive inward motion of the foot—can create an abnormal amount of stretching and pulling on the ligaments and tendons on the plantar fascia.

Other conditions can also bring about heel pain.

Rheumatoid arthritis and other forms of arthritis, such as gout, can cause heel discomfort in some cases.

Haglund's deformity ("pump bump") is a bone enlargement at the back of the heel bone, in the area where the Achilles tendon attaches to the bone. This sometimes painful deformity is the result of bursitis caused by pressure against the back of the shoe, and can be aggravated by the height or the pattern of stitching of a heel counter of the shoe.

Pain at the back of the heel can also be due to Achilles tendinopathy. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to early inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. Over time, there is less inflammation and more tendon degeneration. The treatment of choice is ultrasound-guided percutaneous needle tenotomy with platelet-rich plasma injection.

Bone bruises are common heel injuries. A bone bruise or contusion is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.

Stress fractures of the heel bone also can occur, but these are less frequent.

A variety of things can be done to avoid heel pain:

• Wear good quality supportive shoes
• Do not wear shoes with excessive wear on heels or soles.
• Warm up and do stretching exercises before and after running.
• If obese, lose weight.

Early treatment might involve oral anti-inflammatory medication, exercise, shoe adjustments, taping or strapping, or use of orthotic devices. Taping or strapping can help support the foot. Physical therapy may be useful.

A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons.

Ultrasound-guided percutaneous needle tenotomy with injection of platelet-rich plasma (PRP)- a minimally invasive procedure may the treatment procedure of choice since it helps a patient avoid open surgery.

Another treatment that also works well is ultrasound guided injection of Botox.

Only a relatively few cases of heel pain require surgery.

For more information on heel pain and tendonitis and fasciitis, visit our sister site: Tendonitis And PRP

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