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Special shoe inserts can reduce the pressures on the nerve and may be appropriate for certain foot types whereas, on other occasions, local injections of medication to the area where the tibial nerve is inflamed may be necessary. If this is suspected, an X-ray is required to confirm final diagnosis and to determine the extent of the injury and a follow-on treatment plan. This condition is temporary and self-limiting but can be painful at the time.
Rest and stretching exercises may help. Treatment involves special exercises that strengthen the tendon and increasing the height of the heel with an insole on a temporary basis. Follow the self-care measures above in the first instance. If you experience any foot care issues that do not resolve themselves naturally or through routine foot care within three weeks, it is recommended that you seek the help of a healthcare professional. To talk to a podiatrist also known as a chiropodist about the options available regarding treatment, you can contact an NHS podiatrist or a private practice podiatrist.
In both cases, always ensure that any practitioners you visit are registered with the Health and Care Professionals Council HCPC and describe themselves as a podiatrist or chiropodist.
Heel bumps: These are firm bumps on the back of the heel, usually caused by excessive shoe rubbing in the heel area, or the thickening of the tissues associated with a tight Achilles tendon. Tarsal tunnel syndrome: This can feel like a burning or tingling sensation under the heel within the arch of the foot with occasional loss of sensation on the bottom of the foot. Chronic inflammation of the heel pad: This is caused by a heavy heel strike or sometimes a reduction in the thickness of the heel pad which can give rise to a dull ache in the heel which increases during the day.
Fracture: Often caused following injuries such as falling from a height or landing on an uneven surface. Sever's disease calcaneal apophysitis : This painful condition affects young children, usually between the ages of 8 and 12, especially those who are physically active or undergoing a growth spurt. Achilles tendonosis: This condition occurs when the Achilles tendon is placed under more pressure than it can cope with and small tears develop along with inflammation and in some cases can lead to tendon rupture. Who gets it? How do I know I have it? Is it serious? What are the treatments?
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Heel bursitis calcaneal bursitis : Medication and ultrasound can give relief but for the long term, a shoe insert may be necessary. Heel bumps: Adjustments to footwear is usually enough to make them comfortable, although a leather heel counter and wearing boots may help.
Chronic inflammation of the heel pad: A soft heel cushion can help this condition. Sever's disease calcaneal apophysitis : This condition is temporary and self-limiting but can be painful at the time. Achilles tendonosis: Treatment involves special exercises that strengthen the tendon and increasing the height of the heel with an insole on a temporary basis. How can I prevent it? When should I see a podiatrist? To see a private practice podiatrist, use our search Find A Podiatrist. While deciding which applies to you best left to your doctor, knowing more about them can help you prepare for that conversation.
Plantar fasciitis refers to irritation and inflammation of the tight tissue band that forms the arch of the foot and connects your heel bone to the base of your toes. The severe, stabbing, or throbbing pain of plantar fasciitis is felt on the bottom of the heel and occurs upon weight-bearing after rest, such as when taking your first steps in the morning or when standing up after prolonged sitting. If plantar fasciitis persists for a long time, a heel spur—a bony protrusion—may form where the fascia connects to your heel bone. Rarely, the plantar fascia may tear rupture.
The pain of plantar fascia rupture is severe, sharp, and sudden, and there may be swelling and bruising present as well. The tightening or burning pain of Achilles tendonitis is located at the part of the tendon that is slightly above the heel bone. Mild swelling around the tendon and morning stiffness in the heel and calf are also often experienced.
Heel Pain (Plantar Fasciitis)
Achilles tendonitis most commonly develops from overuse e. Bone spurs from wearing poor-fitting shoes or arthritis may also lead to Achilles tendonitis. Rarely, the Achilles tendon ruptures ; this typically occurs as a result of engaging in a vigorous type of physical activity where the foot pivots suddenly as in basketball or tennis. Besides severe heel pain, some people report hearing a "pop" or "snap" when the tendon tears. Other causes of heel pain must also be considered, even if you've experienced this discomfort and gotten one of the above diagnoses before:.
Tarsal tunnel syndrome is a nerve condition in which a large nerve in the back of the foot becomes pinched. Tarsal tunnel pain, described as aching or burning, may be felt in the heel but is more common in the bottom of the foot and near the toes. Similar to carpal tunnel syndrome in the hand, numbness and tingling may be present, and the pain is often worse at night. Stress fractures of the foot and heel commonly occur in athletes or long distance runners who increase their running mileage over a short period of time.
Repeated stress on the heel bone eventually leads to a break. A stress fracture causes significant pain that intensifies with activity and improves with rest. In addition to pain, swelling may be present, along with tenderness felt in the area of the bone break. A heel pad bruise causes a sharp pain over the bottom of the heel. It may occur after trauma e. In older adults, the cushioning fat of your heel pad may atrophy or breakdown. Unlike plantar fasciitis, the pain of fat pad atrophy is absent in the morning but worsens with activity during the day. Heel pad syndrome is due to thinning of this fat pad that results from trauma, such as the consistent pounding of the foot in marathon runners or pressure put on the foot due to obesity.
This causes a deep, aching pain felt in the middle of the heel that worsens with weight-bearing activity. Haglund's syndrome , also referred to as "pump bump," occurs when a bony prominence at the back of the heel rubs against rigid shoes.
Everything You Need to Know about Plantar Fasciitis
The pain of Haglund's syndrome is felt at the back of the heel and may be associated with limping and signs of inflammation like swelling, warmth, and redness. As the soft tissue surrounding the bony bump at the back of the heel gets irritated, bursitis may develop. Retrocalcaneal bursitis causes pain deep in the back of the heel, while calcaneal bursitis pain is felt on top of to the side of your Achilles tendon.
The sinus tarsi, referred to as "the eye of the foot," refers to the space on the outside of the foot between the ankle and heel bone.
This space, while small, contains several ligaments, as well as fatty tissue, tendons, nerves, and blood vessels. Rolling out your ankle often triggers this syndrome, which may lead to pain with weight-bearing activities, a sensation of ankle looseness, and difficulty walking on uneven surfaces, like grass or gravel.
Piezogenic papules are painful, yellow or flesh-colored heel bumps that represent fat from deep within the skin pushing through the heel capsule called fat herniation. The papules are benign and only cause pain in less than 10 percent of cases. The cause is unknown, although experts suspect the papules may result from a hard heel strike during walking.
Interestingly, they are a characteristic skin finding in people with the connective tissue disease Ehlers-Danlos syndrome. Rarely, an infection of the heel bone called osteomyelitis may cause pain—although, unlike most other sources of heel pain, the pain from an infection of the heel bone is usually constant. A fever may also be present. If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, seek medical attention.
Most heel conditions can be diagnosed with a medical history and physical examination alone. A detailed medical history is often the crux for diagnosing heel pain. With that, it's sensible to come prepared to your doctor's appointment with answers to these basic questions:.
During your physical exam, your doctor will inspect and press on "palpate" various areas of your foot, including your heel, as well as your ankle, calf, and lower leg. By doing this, she can check for areas of focal tenderness, swelling, bruising, rash, or deformity. She will also likely evaluate your gait, as well as move your foot and ankle around to see if that elicits pain.
While blood tests are not commonly ordered for the diagnosis of heel pain, your doctor may order one or more laboratory studies if she suspects or wants to rule out a particular condition. For example, a white blood cell count or erythrocyte sedimentation rate may be ordered if a bone infection is being considered. An X-ray of the heel may be ordered to diagnose certain conditions like a stress fracture of the heel, Haglund's syndrome, heel spur, or bone tumor.
Less commonly, other imaging tests are used. For instance, magnetic resonance imaging MRI may be used to diagnose a soft-tissue injury or an infection.
Some questions answered
While it is reasonable to think that heel pain must stem from your heel, this is not always the case. Sometimes pain is referred to the heel, as in certain neurological conditions.
Irritation of a nerve in the lower back called radiculopathy may cause pain of the calf muscle that moves down the leg into the heel. In addition, peripheral neuropathies associated with diabetes, alcohol abuse, or a vitamin deficiency can cause diffuse foot and heel pain. Besides a neurological exam, an MRI or nerve conduction studies may be ordered to diagnose nerve problems. Skin problems, like an infection of the hindfoot or ankle cellulitis , plantar wart , diabetic ulcers , or fungal foot infection e.
A medical history and physical exam are usually sufficient to diagnose a skin problem of the heel, although blood tests or a biopsy of the affected area may be needed. Whole-body inflammatory diseases like sarcoidosis , rheumatoid arthritis , or reactive arthritis may cause heel pain. Oftentimes, other symptoms are present with these systemic diseases, such as fever, rash, and joint pain and inflammation. Laboratory and imaging studies are also used to diagnose systemic diseases. Treatment depends entirely on the root cause of your heel pain.
If you are unsure of your diagnosis, or how severe your condition is, be sure to seek medical advice before beginning any treatment plan. Some common treatments are listed here—but keep in mind, not all of these are appropriate for every condition. In other instances, resting can help to eliminate the most severe pain until you are able to see your doctor or a podiatrist. For most sources of heel pain, applying an ice pack over the heel for minute intervals up to four times daily can help diminish swelling and soothe your pain.
Be sure to place a thin towel between the ice pack and the skin of your heel. Taping the foot with sports tape or hypoallergenic tape is useful for certain heel diagnoses like plantar fasciitis, heel pad bruise, and heel pad syndrome. For plantar fasciitis, your doctor may recommend a taping technique involving four strips of tape that get applied around the foot and heel. The tape should not be applied too tightly and can stay in place for one week.
Exercises and stretches are designed to relax the tissues that surround the heel bone. Some simple exercises, performed in the morning and evening, often help patients feel better quickly. For Achilles tendonitis, your doctor may refer you to a physical therapist who uses a specialized exercise program called the Alfred protocol, which focuses on eccentric loading of your Achilles tendon. Depending on the cause of your heel pain, various foot supports may be recommended by your doctor. For instance, for plantar fasciitis, your doctor may recommend wearing splints at night to keep your foot straight.
Likewise, heel wedges or shoe orthotics may be recommended for the treatment of Achilles tendonitis. For Haglund's syndrome, your doctor may recommend altering the heel height of your shoes. Nonsteroidal anti-inflammatory medications NSAIDs are commonly prescribed for heel pain caused by problems such as plantar fasciitis, Achilles tendonitis, a heel pad bruise, Haglund's syndrome, heel bursitis, heel pad syndrome, and sinus tarsi syndrome. Sometimes, cortisone —a steroid that reduces inflammation—may be injected into the heel to ease the pain temporarily for a few weeks, usually.
While immediate surgery is needed nearly all the time to treat an acute Achilles tendon rupture, for other causes of heel pain, surgery is generally only recommended if non-surgical therapies have not worked for a period of six to 12 months. For example, with plantar fasciitis, surgery to detach the plantar fascia from the heel bone called plantar fascia release may be performed if all other treatments have failed for one year. Another surgery called gastrocnemius resection in which the calf gastrocnemius muscles are lengthened may also be performed for persistent plantar fasciitis.
Preventing symptoms of heel pain may be a critical component of the long-term treatment of your condition. Depending on the exact source of pain, prevention strategies may slightly differ. But in general, there are some steps that you can take to avoid a recurrence of heel pain symptoms. Some causes of heel pain are more serious than others.
Regardless, your doctor can help you figure out what's causing the discomfort and craft a treatment plan that will help your specific situation.