Heel Pain: Causes and Treatment

Heel pain is probably the most common foot pathology. It is estimated 100,000 individuals in the United States suffer from this condition. In most cases, acute heel pain is simple, easy and affordable to treat. Unfortunately, a lot of people have the wrong approach in heel pain management and treatment, and this could lead to chronic heel pain.

Causes Of Heel Pain

There are a lot of conditions that can cause heel pain but the common culprits are plantar fasciitis and Achilles tendinitis.

Plantar fasciitis is due to overstretching of the plantar fascia causing multiple microscopic tears along the fibers of the fascia. The plantar fascia is a strong connective tissue located underneath the foot. It attaches below the calcaneous or heel bone to the digits of the foot. The plantar fascia plays a vital role in maintaining the arch of the foot; hence, this structure is constantly under stress.

Achilles tendinitis, on the other hand, is due to injury of the Achilles tendon causing heel pain behind the foot. The Achilles tendon attaches behind the heel bone to the calf muscles above. Achilles tendinitis is particularly common among women who use improper foot wear such as high heels.

Heel Pain Symptoms

Typical pain for plantar fasciitis is felt when a person gets out of bed, taking their first steps in the morning. Usually, a stabbing sharp pain is felt at the bottom or front of the heel. This also holds true for Achilles tendinitis but pain is felt at the back of the heel.

The pain will diminish throughout the day as the tendons and muscles adjust and adapt to the swelling. Unfortunately, after periods of rest, the heel pain can return sharper and stronger. During rest, the ligaments of the foot will tighten and shorten. When we get up, the foot receives the full weight of our body and the sudden stretching of the ligaments is the cause of the stabbing pain.

The best way to treat any type of acute heel pain is the RICE (rest, ice, compress, elevate) method. If pain persists, it is very important to have your foot checked by a podiatrist.

Tennis and Common Injuries

With the season in full swing, more and more patients have tennis on their minds and sports often bring associated injuries.

Calf and Achilles tendon injuries

The usual underlying cause in both calf muscle and Achilles tendon injuries is a tight calf muscle-Achilles tendon unit. This muscle-tendon unit crosses both the ankle and knee. You can determine if your calf muscle-tendon complex is tight if you cannot raise the ball of your foot higher than the heel of that foot with the leg extended or straight. A sudden overload from pushing off your foot while your leg is fully extended is the most common cause of injury.

Your physician will evaluate your foot pain using physical exam as well as advanced imaging modalities like x-rays and ultrasound to formulate the best treatment plan possible for your condition.
Achilles tendiniits involves inflammation of the Achilles tendon due to overuse. To manage Achilles tendinitis, decrease playing time, use heel lift in your regular shoes, and stretch the calf muscles with your leg held straight.

A ruptured Achilles tendon is more serious than tendinitis. You may notice a sudden snap in the lower leg, as if someone has kicked you in the back of the foot. Since this is not a very painful injury, the player may be lulled into thinking that the injury is not as severe as it really is. After an Achilles tendon rupture, a player will be able to walk flat-footed, but will not be able to stand up on his or her toes on the affected side. Treatment involves casting or surgery, but surgery is recommended for most Achilles tendon ruptures, especially for athletes.

With tennis leg, which is a tear of the calf muscle on the inside of the leg, you may feel as if you have been shot in the upper calf by a pellet gun. This muscle tear can cause discomfort. It is important to stop playing at once and treat the calf muscle with RICE. Tennis leg may take several weeks to resolve.

Ankle sprains

Sprains of the outer ligaments of the ankle are common in tennis. You can minimize the risk by choosing shoes that are specifically designed for tennis and that have adequate support built into the outer counter of the shoe. The most effective treatment for ankle sprains is the usual RICE for 24 to 36 hours, then walking with adequate support on the ankle. In cases of severe pain, swelling, and bruising, see your doctor. Even for the most minor sprain, some sort of stabilizing ankle support is needed during play for six weeks.

Tennis toe can happen because the toes are jammed against the toebox of the shoe during quick starts and stops in tennis. Tennis toe is a hemorrhage under the toenail that can be very painful. To relieve the pressure, your doctor will treat it by drilling a hole in the toenail. To prevent tennis toe, keep your toenails cut short and wear shoes that provide adequate toe space.

For all cases of heel pain, see your foot doctor for evaluation.