September 17

What Causes Heel Pain?

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What are the Causes of Heel Pain?

Heel pain is one of the most common pathologies that I encounter at the office on a daily basis.  It is also very painful and disabling.  People who work outside or who are on their feet a lot at work are predisposed to the condition.  Other factors play into the occurrence of heel pain.  For example, with the start of spring and summer, people tend to wear more flip flops and non-supportive shoes.   While obesity is not the cause of the problem, it adds to the problem.  And the biomechanics of the feet, tightness of the ligament and muscle groups can all increase the chance for heel pain.

Heel Pain Caused by Plantar Faciitis

Let’s take heel pain that occurs at the bottom of the feet, called plantar fasciitis.  The biomechanics of the feet is a major cause to its development.  The more flat your feet are or the higher arch you have, you can have plantar fasciitis.  The plantar fascia ligament makes up your arch.  When it is stressed due to a recent increase in activities, the ligament develops plantar fasciitis, which is inflammation to the structure at its insertion into the heel bone.  If it goes untreated, it could lead to severe pain.  Initial treatment is geared toward decreasing the patient’s pain level through ice and stretching regimen, and advice for patients to wear supportive shoes.  The second step of treatment is the long-term treatment by getting patient custom orthotics to support the arch and prevent the pain from coming back.

Heel Pain from Achilles Tendonitis

And then, there is posterior heel pain, and it is associated with either Achilles tendonitis or “pump bump” to the heel bone.  In this situation, the tightness to the posterior calf muscles lead to inflammation at the Achilles tendon insertion into the calcaneus.  Anatomically, a muscle group becomes a tendon, which then attaches to bone.  So if your muscles are tight, you are predisposed to strain and inflammation to the tendon at its point of insertion to that bone.  In the treatment of Achilles tendonitis, ice and stretching is the goal standard to getting patients back on their feet.  Patient’s activities have to be modified to allow the tendon to rest.  Preventive care includes a regimen of a long-term stretching on a daily basis to prevent the condition returning.  Supportive shoes and custom orthotics are also indicated.

Haglund’s Deformity May Contribute to Heel Pain

Foot with Bump on heel
Feet exhibiting the condition known as Pump Bump

“Pump bump,” or Haglund’s Deformity, refers to a protrusion of bone at the top to the heel bone in the back of the heel.  It is known as a “pump bump” due to the theory that the aggravation of women high-heeled shoes constantly rubbing at the spot causes the bone to be more prominent.  As a result, inflammation between the bone and the Achilles tendon can develop a bursitis, inflammation of the sac that generally acts as a buffer between the bone and the Achilles tendon.  Treatment includes rest, ice and avoidance of shoes that have a rigid backing.  Again, in this scenario, stretching is the key to feeling better.  A 1/4″ heel lift in the shoe can add the extra relief by taking the stress off the area at the top part of the shoe against the heel bone.

I hope that this blog offers another helpful educational topic in distinguishing the different types of heel pain.  When you go to your doctor, specify the location of the heel pain helps your doctor in the diagnosis of your condition.  In treating these conditions, the above discussion offers a brief outline to the regimen that may work for some people but not for all.  When all fails, please contact us and we will get you back on your feet in no time.

Dr. Dang H. Vu, DPM is a Baltimore Podiatrist with more than 17 years of experience. He completed his residency at Sinai Hospital of Baltimore, where he furthered his surgical expertise. He now holds privileges at Northwest Hospital. He offers services from three Baltimore Locations in Reisterstown, Towson and in the Rotunda Building in Hampden. You can find directions and request an appointment on his website FamilyPodiatryofMD.com


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