When walking, your heels repeatedly hit the ground with considerable force. They have to be able to absorb the impact and provide a firm support for the weight of the body. When heel pain develops, it is very disabling, making every step a problem and affecting your posture.
Types of Heel Pain
Pain on the underside of the heel, often caused by a heel spur, is generally known as plantar faciitis. Heel spurs form due to strain on the structures underneath the foot. The pain is worse on standing, especially first thing in the morning, when getting out of bed. It is more common in patients over forty years old. There are no external visible features on the heel, but a deep, localised, painful spot can be found in or around the middle of the sole of the heel. It is thought that the ligament attaching on the heel bone “pulls” a spur of bone to protrude from the heel bone, which causes pain, although this spur is not always present.
Podiatric treatment is by padding and strapping the heel to realign the stretch of the ligament. In the short term, deep heat is recommended to stimulate the healing process, however, if the condition is chronic, special insoles (orthoses) may be prescribed to help the feet function more effectively, thereby reducing the strain on the ligament. Sometimes patients are referred to their G.Ps. for oral non-steroid anti-inflamatories, alternatively, localised hydrocortisone injections may be required.
Pain on the back of the heel, bursitis, is inflammation of the fluid filled cavity (bursa) at the back of the heel. This bursa normally separates tissues that may suffer friction, like the Achilles Tendon and the heel bone, however, when it becomes inflamed, it is very painful. The pain is felt when the ankle joint is moved and there may be swelling on both sides of the Achilles tendon.
The normal treatment for bursitis is appropriate padding and strapping to alleviate any rubbing on the heel. If infection is present, patients will be referred to their G.P. for antibiotic cover.
Heel bumps occur at the back of the heel as firm swellings which become prominent and may rub against the shoe. They form as a response to pressure.
Normally, adjustment to the footwear is all that is required for heel bumps, however, in persistent cases, surgery might be required.