What causes pain in the heel?
Pain in the heel can be caused by many things. The commonest cause is plantar fasciitis. Other causes include:
- Prolonged standing, especially on a hard surface and wearing hard-soled footwear
- Thinning or weakness of the fat pads of the heel
- Injury to the bones or soft tissue padding of the heel
- Arthritis in the ankle or heel (subtalar) joint
- Irritation of the nerves on the inner or outer sides of the heel
- Fracture of the heel bone (calcaneum)
What is plantar fasciitis?
Plantar fasciitis is the most common cause of heel pain. The plantar fascia is the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel hurts when you stand or walk.
Plantar fasciitis is common in middle-aged people. It also occurs due to overuse in younger people like athletes or soldiers. It can happen in one foot or both feet.
Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen if:
- Your feet roll inward too much when you walk (excessive pronation ).
- You have high arches or flat feet.
- You walk, stand, or run for long periods of time, especially on hard surfaces.
- You are overweight.
- You wear shoes that don't fit well or are worn out.
- You have tight Achilles tendons or calf muscles.
- You suffer rheumatic disorders like rheumatoid arthritis or ankylosing spondylitis.
What is the calcaneal spur?
Near the inflamed plantar fascia attachment, but not in it, some extra bone may form, producing a small "spur". In fact, it is a shelf of bone, not a sharp spur. These "heel spurs" can be found in people with no heel pain. The heel spur is caused by the same process as the heel pain, but the spur is not itself the cause of the pain.
What can I do to help the pain?
You can try to avoid the things that cause heel pain to start:
- Weight control
- Shoes with some padding or shock-absorbing material in the heel
- Moulded insole in your shoe may reduce the stresses on your feet
- Stretching exercises to the Achilles and Plantar fascia
If your heel pain fails to improve with these measures you may wish to seek advice from your GP.
Your doctor will examine you to see what is causing the pain. If the cause of your pain seems obvious, your doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. An X ray will show any arthritis in the ankle or subtalar joint. It will also show a spur if you have one. Occasionally a scan may be used to help spot arthritis or a stress fracture.
What else can be done?
As heel pain is basically a stress problem in the tissues of the heel, the main treatment is to reduce stress.
If the pain continues, a splint to wear on your ankle at night to prevent your Achilles tendon tightening up while you are asleep is often very effective in improving the severe pain that many people get first thing in the morning. There are numbers of other treatments can be tried:
- Further physiotherapy including shock wave therapy.
- PRP or Steroid Injections to the heel.
- Pain control treatments such as transcutaneous nerve stimulation (TENS) or acupuncture.
- Rarely and only if all non-surgical treatments fail would an operation be considered.
Who needs an operation?
It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release or remove part of the diseased plantar fascia from the heel bone and reduce the tension in it.
General Details of Procedure
The procedure may be performed in a number of ways, including through an incision, endoscopic, minimally invasive technique or even with a needle. Each surgical method achieves the goal of relieving the tension on the damaged and painful portion of the tissue.
What happens after surgery?
Patients typically go home the same day of their surgery. Your doctor may advise you to wear a splint, boot or postoperative shoe. You may have restrictions on your weight-bearing for 2-3 weeks after surgery. If you have sutures, they may be removed two weeks after surgery and then normal weight bearing can resume.
There are complications that relate to surgery in general. These include the risks associated with anaesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
How successful is plantar fascia release surgery?
The majority of patients who undergo surgery will have decreased pain and improved function. On average most patients will be able to return to normal weight bearing two to three weeks after surgery. Continued stretching, good footwear and avoiding activities that cause pain are important to a successful recovery.