Pain that happens immediately after an injury or early in an illness may play a protective role, often warning us about the damage we’ve suffered. When we sprain an ankle, for example, the pain warns us that the tendons, ligaments, and soft tissues may be stretched, frayed, and bruised, and that further physical activity may cause added injury. Pain also signals us to seek podiatric medical attention. The signal is of serious importance because of the many ailments that lead to pain in the heel.
Causes of heel pain
Heel pain is a common problem that can be caused by the way your feet move or by the way your feet and legs are built. For many people, heel pain is part of aging. It shows up after your feet have supported you through years of wear and tear. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear; or being overweight. The heel bone is the biggest of the 26 bones in the human foot, which also has 33 joints and a filamentous network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in all areas of the heel.
Heel spurs
A common cause of heel pain is the heel spur, a bony outgrowth at the base of the heel bone near the plantar fascia. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as “heel spur syndrome.” Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. The pain you feel is not from the spur alone. Your heel hurts because the spur pinches a nerve. As with plantar fasciitis, the pain may decrease after standing or walking for a short amount of time.
Plantar fasciitis
Both heel pain and heel spurs are frequently associated with an inflammation of the ligament (fascia) running from your heel to the ball of the foot. The inflammation is called plantar fasciitis. The condition occurs when the plantar fascia is stretched beyond its normal extension, causing the soft tissue fibers of the fascia to tear at points along its length, this leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate arch support and by the chronic irritation that sometimes accompanies an athletic lifestyle. Resting provides only temporary relief. When you resume walking, particularly after a night’s sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.
Excessive pronation
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 adapt to ground surfaces and absorb shock in the normal walking pattern. As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone.
Disease and heel pain
Some general health conditions can also bring about heel pain. Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint, can cause heel discomfort in some cases.
Heel pain may also be the result of an inflamed bursa (bursitis), a small, irritated sack of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur.
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 generally the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe.
Pain at the back of the heel is associated with inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. The inflammation is called Achilles tendinitis. It is common among people who run and walk a lot and have tight tendons. 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 inflammation, pain, and the possible growth of a bone spur on the back of the heel bone.
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.
Children’s heel pain
Heel pain can also occur in children, most commonly between ages eight and 13, as they become increasingly active in sports activity. This physical activity, particularly jumping, inflames the growth centers of the heels. When the bones mature, the problems disappear and are not likely to recur. If heel pain occurs in this age group, podiatric care is necessary to protect the growing bone and to provide pain relief.
Next month: Read about how to prevent heel pain.
For more information on any foot or ankle problem, you may contact Cortese Foot and Ankle Clinic at 309-452-3000. Their office is located at 1607 Visa Dr. in Normal.