The feet perform a great deal of work everyday because they take a huge number of steps. Due to the load they carry, they frequently experience injuries and trauma. This may be incapacitating and restrict every day tasks. Heel pain is one common presenting complaint for Podiatrists and medical practitioners.
Heel pain can arise in individuals of every age group and situation. Middle aged people and older have made use of their feet for a long time and quite often experience foot pain. Overweight individuals place much more force on their feet which may be a real problem. Sporty or really energetic people also put a lot more demands on their feet. When children experience heel pain it is sometimes associated with the growing anatomy.
Plantar fasciitis is probably one of the most prevalent type of heel pain. The plantar fascia is a thick, fibrous band of tissue which runs through the arch of the foot, connecting the heel bone and the forefoot. Traction or excess stretching of the fascia may cause irritation, tears to the fibres and inflammation. It is usually painful beneath the heel the first thing each morning or arising right after rest. Things which might promote plantar fasciitis are poor foot mechanics, excess weight, age and inappropriate footwear.
Pain at the posterior side of the heel is also a common presenting foot complaint. The achilles tendon connects the calf muscles with the back side of the calcaneus or heel bone. Tremendous force occurs through this tendon when the calf muscles contract. This may cause degeneration, or wear and tear of the tendon. This may result in irritation, weakness/tearing of the tendon fibres themselves, and associated inflammation. In severe cases it is possible for the tendon to fully rupture. The pain experienced at the back of the heel is the location where the achilles tendon attaches to the bone, but pain may be experienced further away from the heel, right up into the calf as well.
It is possible that heel pain can also occur through the irritation of a nerve. The tibial nerve runs through what is referred to as the tarsal tunnel The tunnel is formed by the surrounding anatomical structures. Compression or irritation of the tibial nerve in this location can cause, pain, burning,numbness, pins and needles, or possibly muscle weakness and dysfunction. The compression of the tibial nerve and the symptoms associated with this irritation is referred to as Tarsal Tunnel Syndrome.
It is also feasible to have heel pain caused through a stress fracture of the calcaneus, which is the medical name for the heel bone. A stress fracture of the calcaneus is not caused by a one off event. It evolves through repetitive impact to the plantar area of the heel. It can occur in active people such as long distance runners, or soldiers when marching. Over weight people may end up being candidates because of the greater impact forces.
A common cause of heel pain in younger people can be a ailment referred to as Severs Disease. It's aged linked and usually occurs in active patients between 10 and 14 years of age. Around this time there is a growth spurt and there may be irritation to the growth plate of the calcaneus, particularly during sport. The young person suffers from pain around the back of the heel, it can be tender to squeeze the heel, they may hobble and it is regularly worse after sport.
To successfully treat a painful heel it is essential to make a correct diagnosis. Factors to consider are age of patient, activity, weight and when the pain occurs. Determining which anatomy is involved is vital. Biomechanical assessment is important, which includes checking gait, range and quality of joint movement, as well as muscle strength and tightness. Once a diagnosis is made a treatment plan can be implemented. Depending on the pathology, treatment may incorporate muscle strengthening and stretching, footwear modification, the use of in shoe orthotics, and anti inflammatory measures.
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