A patient named Richard recently came to me for what he described as pain in his heel. His story is not unlike others I've heard and I believe it's worth repeating in his own words:
"I'm a construction worker and have to be on my feet most of the time. My feet never gave me any trouble until a few weeks ago when I had to carry lumber up and down stairs several times a day. After about a week on the job I noticed pain in my heel to the extent that I could barely walk. I had a vacation coming up so I thought I'd give it a rest to see if it got better. But it's just as bad and even worse first thing in the morning. What can possibly be causing it?"
SEVERS
Heel pain happens to be the most common foot problem and affects two million Americans every year. When you consider the amount of stress you put on your feet on a daily basis by just standing and walking, it's amazing there aren't more feet problems. Injuries to the ligaments, muscles, and tendons of the legs produce painful conditions that can also plague your feet.
Richard's case is not unusual. As a guy in his upper 50's who has worked in a physical job most of his life, he depended on his feet to keep him going. After years of pounding his feet finally said, enough! Most people take their feet for granted. Let's face it; unless you have pain in every step, you happily go about your daily activities without consideration for the harm you might be doing to your poor feet.
Why is your heel the most likely to be affected? As the largest bone in the foot and the part that absorbs the greatest amount of pressure, the heel often hits the ground at increased velocity especially during high impact aerobic activities. The pain can occur in the front, back, or bottom of your heal. Some of the most common symptoms are:
• Morning Heel Pain - Although staying off your feet will relieve the pain temporarily it returns promptly when weight is placed on your feet for the first time in the morning pain.
• Tenderness and Swelling - This can be the first sign that something is wrong. Many people don't realize that they have an injury until they feel tenderness and swelling in their heel.
• Localized Pain - Indicating where the pain is felt helps to determine what the problem might be.
• Numbness and Tingling - This could indicate a pinched nerve or a heel spur interfering with nerves functioning properly in the heel.
What Can Possibly Be Causing The Pain?
When patients like Richard complain of heel pain it is important to gather as much information about lifestyle and overall health issues. There are several risk factors that may contribute to foot pain such as obesity, diabetes, standing on your feet most of the day, suddenly becoming very active, or having flat-feet or a high arch.
Aging also plays a role in developing heel pain. As you get older, the fat pad on your heel becomes thinner and can't absorb as much stress from walking or running. Additional shock can damage the plantar fascia and cause it to swell, tear or bruise. Other factors include:
• Shoes - How your shoes fit and support your feet is extremely important. Ill-fitting shoes can put pressure on your heel, add strain during movement and cause misalignment throughout the foot.
• Exercise - Athletes often overdo it and find themselves adding strain to the heel of the foot. Taking the proper precautions before and after workout, wearing supportive athletic shoes, and gradually warming up to a more rigorous work-out can prevent possible injuries.
Some common medical conditions affecting heels and feet include:
• Plantar Fasciitis - This is the most common cause and occurs when the ligament that runs the length of the bottom of the foot (plantar fascia ligament) becomes inflamed due to a tear. Pain is usually felt in the front underside of the heel as an indication of plantar fasciitis.
• Heel Spurs - These are pointed, bony fragments that extend from the heel and point forward toward the toes. When the spur tears through tissue and nerves of the foot pain can be excruciating.
• Achilles Tendonitis - in this condition, the tendon along the back of the heel and ankle (Achilles tendon) tears and becomes inflamed causing pain in the back of the heel.
• Severs Disease - Common in children ages 9-15 this condition sometimes develops from strenuous physical activity. It causes pain in their feet, particularly their heels. Pain in the lower back portion of the underside of the heel can signal the development of Severs Disease.
• Metatarsalgia - A condition affecting the ball-of-foot area which becomes inflamed often caused as a result of wearing high heeled shoes.
• Tarsal Tunnel Syndrome - This condition is similar to carpal tunnel syndrome of the wrist but in this case it is the tibial nerve that becomes pinched causing inflammation and pain.
What Can You Do About Heel Pain?
There are some very simple things you can do for heel pain. If you are a runner or do high impact aerobics, cut back on your workouts, at least temporarily. Ask your doctor about using inserts for your shoes called orthotics that help support your feet. If you are overweight, try losing a few pounds to relieve some of the pressure on your feet. If you have to stand for long periods of time, place some type of padding on the floor where you are standing. This helps to provide a cushion to lesson your heel pain.
Stretching exercises are also beneficial and should be done at least twice a day. Stretching should be done with slow, gradual movements...no bouncing. Stand with your hands against a wall and your painful leg slightly behind your other leg. Keep both heels on the floor and slowly bend both knees, holding the stretch for 10-15 seconds. Repeat 6-8 times a day.
Over the counter pain medications may be helpful such as Tylenol, Aleve, or ibuprofen to help with the inflammation and to ease your pain. Consult your doctor before taking any medication.
Treatments for heel pain are effective in 90% of patients who seek medical help and take the necessary steps to relieve their discomfort. Remember to see your doctor when you feel the first sign of pain to effectively treat the condition and keep it from returning. As for Richard, he is back on his feet with new orthotics fitted to relieve the pressure on his heel. Don't wait if heel pain is your problem. You too can be up and running again in no time!
Mark Bromson, M.D.
Foot and Heel Pain SEVERS
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