Learn About Heel Pain

Heel pain is a very common problem of the foot in adults. It is a general complaint that can be due to several causes. When treating heel pain, it is imperative to identify the specific cause of the pain because each treatment modality is specific for a certain heel problem.

Before you schedule for an appointment, it is best to know two of the common causes of heel pain.

The most common cause of heel pain is plantar fasciitis. The plantar fascia is a strong and thick connective tissue that runs from the calcaneus or the heel bone to the toes of the foot. Basically, it is responsible in maintaining the arch of the foot and it undergoes stress when bearing weight. Injury or inflammation occurs when the fascia becomes too tight or undergoes severe stress when lifting, running or simply being overweight. The pain associated with plantar fasciitis is due to prolonged standing and walking.

Posterior heel pain involves pain at the back of the foot or heel. Also known as Achilles tendinitis, this involves the injury and inflammation of the Achilles tendon. The Achilles tendon is the largest and strongest tendon in the body; it attaches the heel bone (calcaneus) to the calf muscles (soleus and gastrocnemius). This tendon works like a spring when walking and running. This spring reaction or elastic storage energy can generate a running speed 80% or more. Injury and inflammation occurs due to overuse and sudden or forceful stretching that can tear the tendon, similar to those seen in Olympic runners.

Both of these conditions can effectively be treated by Extracorporeal Shock Wave Therapy or ESWT. Approved by the FDA to treat plantar fasciitis, ESWT can also be used in Achilles tendinitis. Very similar to ultrasound, this procedure locally stimulates the body's own healing process in dealing with tendinitis.

Pain at the Back of the Foot

Image via WikipediaThe Achilles tendon is the largest and toughest tendon in the body. It is an essential structure that helps us balance. It is important in running and walking. This tendon can store energy when running, it works very much like a spring, and this springing action can increase running speeds without using much energy.

Tendons and ligaments are very similar in structure and function, the only difference is their attachment. Tendons attach muscle to bone and ligaments, ligaments attach bone to bone.

From above, the Achilles tendon attaches to the calf muscles: soleus and gastrocnemius muscles. And from below, the tendon attaches to the middle portion of the calcaneus, also called heel bone. Directly above the attachment on heel bone, there is a fluid-filled, pillow-like structure called the Retrocalcaneal Bursa. This serves a cushion between the Achilles tendon and heel bone, preventing these structures from being "rubbed together".

Foot pain is one of the most common foot complaints in adults of all ages. There are many causes of pain involving this area and pain affecting the posterior or back of the heel involves all structures discussed above. The following are the pathologic conditions involving each structure:

Retrocalcaneal bursitis is a swelling or inflammation of the retrocalcaneal bursa. Too much use of the ankle sometimes irritates this bursa and cause painful inflammation. This condition is often triggered by aggressive exercise or a sudden increase in activity without initial stretching and conditioning.

Calcaneal Spur. Normally, there is a bony prominence that is palpable at the heel bone. This is actually the insertion of the Achilles tendon to the calcaneal bone. Over time, this bony prominence can enlarge irritating the Achilles tendon. This bony growth is called Haglund's Deformity (pump bump).

Achilles tendinitis is an inflammation of the Achilles tendon. The cause can be due to the conditions above, tear during strenuous activities, or the natural "wear and tear" degeneration because of aging.

An accurate diagnosis is imperative in treating heel pain. For more information about heel pain and its proper treatment, please visit Dr. Kevin Lam DPM at Family Foot and Leg Center P.A.

The Use of ESWT for Heel Pain and Other Joint Pains

Extracorporeal Shock Wave Therapy or ESWT is a new treatment used for heel pain, foot pain, various types of joint pains. This new medical device is approved in the US by the FDA for treating foot pain due to plantar fasciitis and tennis elbow. There are many more future approvals from the FDA with the use of ESWT for other health conditions like Achilles tendinitis, patella tendinitis and a lot more.

ESWT is a unique treatment because it stimulates the natural healing properties of the body and can cure chronic pain. There are two theories on how this device promotes tissue healing:

1. The shock waves produced by ESWT machine induces microscopic injuries to the affected area, creating new growth of vascularisation. Increased vascularisation means more blood flow to the injured muscle tissues, ligaments and tendons.

2. Since there are tiny injuries produced by shock wave, the body naturally treats the newly induced injuries and at the same time heals old joint injuries that the body has been ignoring or desensitized to. This makes ESWT very ideal for treating chronic pain.

Extracorporeal is a medical term which means that a medical procedure is done outside the body. It is a low-risk and non-invasive procedure with minimal or no side effects.

The procedure is simple and is very similar to ultrasound. First, the damaged tissue is located around the painful area of the body. Once the targeted tissue is found, multiple shock waves are introduced to create micro injuries which actually help to induce the natural healing process, creating new tissue growth and therefore repairing new or chronically damaged tendons.

This is all done in just 30 minutes and depending on the extent of damage, it may require successive sessions to treat the pain. Some patients feel mild discomfort after the procedure. For some, the pain relief is observed with a single treatment while for others, heel pain is relief is gradual with ESWT treatment.

Things You Should Know About Heel Pain

Image via WikipediaHeel pain is probably the most common foot problem in adults. It occurs mostly among active individuals, people who are overweight, those using improper of footwear, females, and those who have reached the age of 40 and above.

While walking, the foot has a vital role of absorbing all the weight of the body. At the same time, the feet help provide stability and balance. The foot has a total of 26 bones and the heel bone is the largest.

The heel is the part of the foot that first comes in contact with the ground while walking. Daily walking or other activities like running or jogging can put stress to the heel. Over time, this stress can result to injury to the heel leading to heel pain.

At first, heel pain is only minimal and is quite tolerable. This is commonly ignored because the heel naturally heals itself and the pain usually disappears. But in some cases, the healing process is overcome with the constant injury induced by daily activities. If this is not addressed properly and again ignored, this can lead to heel pain.

The occurrence of chronic heel pain happens when an acute pain is managed with pain medications. Pain relievers help alleviate or totally stop the pain. This is an improper way of treating foot pain because it can mask foot problems which can actually get more severe in the future. When the pain is gone we continue to use the injured foot instead of resting it and giving it time to heal.

Heel pain in general can be caused by several factors but commonly involves injury to the plantar fascia (plantar fasciitis) and the Achilles tendon (Achilles tendonitis). In some cases, the cause is muscle tension and strain. Bone formation can occur due to the inflammatory response called periostitis. The bone always grows towards the pulling and can cause severe pain.

Whenever heel pain is felt, it is best to consult a podiatrist or foot doctor at once for proper evaluation.