Did you know that nearly a quarter of the patients between the ages of 45 and 64 that are seen by a podiatrist complain of heel pain? Heel pain affects approximately 1 percent of the U.S. population. The causes of heel pain vary depending on a person’s level of activity, foot type, and biomechanics. However, when discussing heel pain it is important to differentiate pain that is located at the back of the heel which is called Achilles Tendinitis; from pain that is located at the bottom of the heel, which is called Plantar Fasciitis. There are differential diagnoses that one needs to consider as well, including: Achilles tendon rupture, plantar fascia ligament rupture, stress fracture to the heel, inflammatory arthritis (i.e. rheumatoid arthritis), tarsal tunnel syndrome, Haglund’s deformity and Bursitis.
In this blog we will look specifically at Plantar Fasciitis, Achilles Tendinitis, and Heel Spurs.
This condition causes pain at the bottom of the heel. It is named after the ligament that is inflamed. The plantar fascia ligament stretches from the heel bone to the ball of the foot. On average, a person takes 3 to 4 thousand steps a day. A person places 1.5 times of his/her weight with each step on the foot. Imagine the stress to the foot on a daily basis. Plantar fasciitis occurs often in active group of people, whether it is being on their feet at work or extracurricular activities. Non-supportive shoes may also precipitate the condition, especially in the summer months with people wearing flip flops. Also, the poor biomechanics of the feet, whether it’s flat feet or extremely high arches, could give rise to heel pain.
This condition occurs with pain to the Achilles tendon at the back of the heel. The anatomy to the back of the leg shows that the posterior calf muscles become the Achilles tendon, which attaches to the heel bone. Tightness of the calf’s muscle group is the culprit to this condition. As the foot functions during the gait cycle, the foot is raised to clear the ground. The heel then strikes the ground, and the foot pushes off at the ball for the next step. The flexibility of the calf muscles is required during the gait cycle. Otherwise, it causes extra tension at the insertion of the tendon to the heel bone, causing inflammation and pain. For example, climbing a hill or going up and down the stairs are activities that are usually cumbersome for people suffering from this condition.
Heel spurs are extra bones that form to the heel. It can occur at the Achilles tendon insertion to the posterior heel or at the insertion of the plantar fascia ligament at the bottom of the heel. Heel spurs can be particularly prominent at the back of heel and cause irritation in closed shoes. They form as the result of the stress and strain of the ligament and tendon at their insertion to the heel bone. Most of the time, it is not the heel spurs that medical providers target in the treatment of heel pain. It is the inflammation to the tendon and ligament that we focus on to decrease pain and stress to these soft tissue structures.
The initial treatment for the Achilles tendinitis and plantar fasciitis is to decrease pain and swelling to these areas. Ice and stretching is the recommended plan. The so-called “runner stretch” where one tries to stretch the calf muscles to make it more flexible is very effective to relieve pain. Although the calf stretch is more felt at the posterior leg, this same stretch is a “silent” stretch for the plantar fascia ligament as well. Anti-inflammatories, if tolerated, can be used to take away the inflammation and pain. Assessment of one’s shoes is important to see if there is a need to buy newer shoes or more supportive shoes. Cortisone injection and physical therapy are also used at a doctor’s discretion to return a patient to functional level. Ultimately, custom orthotics are the single most effective long-term treatment for heel pain. The orthotics will support the plantar fascia ligament and address a person’s poor positioning of the feet. They will return the patient’s heel to neutral position, thereby relieving pressure to the Achilles tendon. Heel pain can be debilitating. If pain lingers, it is harder to treat chronic pain. Studies have shown that conservative treatment is effective in ninety percent of the cases. A podiatric visit may offer the definitive treatment plan.
Dr. Dang H. Vu, DPM is a Baltimore Podiatrist with more than 18 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 Hampden. You can find directions and request an appointment on his website FamilyPodiatryofMD.com