3 different types of heel pain:
- General Heel Pain Syndrome.
- Plantar Fasciitis.
Heel Pain Syndrome is caused by repetitive pressure placed on the heel of the foot when walking, which causes soreness of the heel.
"Itis" usually refers to the inflammation of a certain part of the body, therefore Bursitis refers to the constant irritation of the natural cushion that supports the heel of the foot (the bursa). Bursitis is often associated with Plantar Fasciitis, which affects the arch and heel of the foot.
Plantar Fasciitis is caused by inflammation of the tissues connected to the heel bone, due to excessive pulling and stretching of the fibrous bands that support the arch of the foot. Continuation of this irritation can lead to heel pain, arch pain or a bony growth on the bottom of the heel bone called a "heel spur". Another condition related to Plantar Fasciitis is swelling on both sides of the Achilles tendon.
Bursitis and Plantar Fasciitis can occur when a person increases their levels of physical activity or when the heel's fat pad becomes thinner, providing less protection to the foot.
Other causes can include:
- Ill fitting shoes.
- Biomechanical problems (e.g. mal-alignment of the foot, including over-pronation).
- Rheumatoid arthritis.
Prevention & treatment of heel pain:
Arch supports and orthotics (special insoles) are the best treatment for this type of condition as they gently support the longitudinal arch of the foot allowing it to settle into a more natural position.
Arch supports or adhesive pads can also help to strengthen the arch but orthotics may be a more permanent solution. An orthotic device (special insole) such as a heel cup or heel cradle will help to absorb shock to the heel by raising the heel, which will redistribute pressure and provide a cushion for the plantar fascia. If the heel pain is caused by over pronation then an orthotic with medial posting that supports the arch will correct over pronation preventing further heel pain.
Appropriate footwear is a key consideration in preventing heel pain, therefore shoes must be spacious and supportive.
Plantar Fasciitis and Bursitis can also be treated by:
- Cold presses or ice packs.
- Anti-inflammatory tablets.
- Cushioning products.
- Massaging the foot / muscle stimulation.
- Stretching exercises.
- Insoles or orthotics.
When is surgery needed?:
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.
No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.