Plantar Fasciitis: Plantar fasciitis is caused by abnormal pulling and stretching of the fascia within and at the heel bone. This results in post static dyskinesia (pain after sitting or resting) in the arch or heel. This is actually due to the body trying to heel the area as edema or inflammation is the first stage of healing. However, the short time you are off your feet is not enough time to go through the stages of healing. Also, we typically over inflame, thus pain when we stand on it.
Fat Pad Atrophy: Fat Pad Atrophy is the thinning of the fat pad under the heel bone. This can result in foot pain when walking or running due to the heel bone becoming bruised. It can even occur with losing weight too fast.
Inflamed Nerve: A palpable cord like structure across the bottom of the heel bone can become inflamed causing pain.
Posterior Tibial Tendonitis: This occurs when the posterior tibial tendon becomes strained or starts to degenerate. It is the long tendon responsible for lifting up the medial (inside) arch. If significant it can feel as if the pain extends to the heel area.
Tarsal Tunnel Syndrome: This is a result of compression of the nerve at the inside of the ankle. Just like carpal tunnel syndrome in the wrist. This can extend pain along the nerve to the heel. I’ve even seen the inflammation about the heel extend into and under the tarsal tunnel giving the same symptoms.
Bursitis: A fluid filled sac on the bottom of the heel bone that comes painfully inflamed. This is usually from a lack of natural foot mechanical shock absorption.
Other possibilities, yet rare are pain from a heel spur, arthritis, a stress fracture, bone or soft tissue tumor or skin condition.
The main cause of heel pain is usually faulty biomechanics.
The treatment plan could vary depending on the diagnosis. For example, a heel pad may work for fat pad atrophy but chances are it will not do much for someone suffering from posterior tibial tendonitis.
Treatment plans are most successful when the cause of the pain is targeted instead of solely attempting to relieve the symptom. As stated before, faulty biomechanics are typically the cause. Over the counter arch supports and custom orthotics are designed to realign the body for proper alignment. Therefore, treatment plans involving an ideal fit and well structured shoe combined with an arch support is often times the most successful in eliminating heel pain.
However, it is important to remember that not all orthotics and inserts are the same. Be careful of inserts or shoes that target a certain condition. For example, a shoe claiming to cure plantar fasciitis may help some but may not help others with the same condition. This is because the insert and/or shoe needed will depend on your foot type. It is important to consult with a specialist who knows feet as well as those who are trained in properly fitting shoes.
Fun Fact: Roughly 80% of people wear their shoes too small!
Products Available at ArchMasters:
Relaxes foot muscles and stimulates circulation. Recommended to those suffering from plantar fasciitis. This, along with a contrast bath before bed, typically saves patients from pain when getting out of bed in the morning.
Silicone Heel Cups are designed to provide shock absorption and cushioning for your heels.
For more information, please visit American Podiatric Medicine Association-Heel Pain.
A heel spur is an abnormal growth of bone at the area where the plantar fascia attaches to the heel bone on the bottom or at the area the achilles tendon attachments on the back of the heel bone.
Heel spurs typically are caused by a long term strain on the plantar fascia, achilles tendon and muscles of the foot. This is especially common in runners and people who suffer from obesity.
Similar to plantar fasciitis, shoes that are worn out, poorly fitting or poorly constructed can aggravate the problem. Heel spurs may not be the cause of heel pain even when seen on an x-ray. In fact, they may develop as a reaction to long term inflammation of the area.
When you receive an injection for a heel spur, the pain may subside but the spur itself does not go away or dissolve. Rather, the injection medication diminishes inflammation and thus diminishes pain. The spur is still there, it just does not hurt anymore. This is one reason one should attempt to alleviate not only the pain but what caused the pain or spur. This is typically done through the use of appropriate footwear and custom orthoses.
Besides injections and surgery to remove the spur, padding, topical pain relievers and physical therapy may help as well.
X-Ray image of heel spurs.
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