Disorders and Treatments
for Painful, Inflamed Heels
Sharp pain, aching or stiffness on the bottom of one or both heels is
a very common ailment. The pain is often at its worst upon awakening
in the morning (or after sitting down for an extended period and then
resuming activity), causing hobbling or limping for a few minutes before
a comfortable stride can be resumed. As weight continues to be applied
during walking or standing, mild or severe pain may persist.
office worker, laborer or athlete develop the problem most frequently,
although children, too, can be affected if the growing bone becomes
Causes of Heel
Heel pain originates deep within the foot, directly on the heel bone
or within the foot's connective tissues, called the fascia.
of fatty tissue surround the heel bone, softening the impact or walking
and running and protecting the bones and muscles of the foot. Beneath
this padding, a fibrous band of connective tissue (the fascia) extends
from the heel bone, supports the arch and reaches across to the toes.
Pain can result when these tissues become irritated or inflamed, or
when small spurs grow on the heel bone.
Most cases of heel pain are characterized by inflammation. First, the
fascia begins to pull on the bone and the tissues become irritated,
then inflamed. Inflammation of the fascia is called fascitis.
A projection or growth of bone may be called a spur, and can grow where
the muscles of the foot attach to bone. While some heel spurs are painless,
others that are determined to be the cause of chronic heel pain may
require medical treatment or surgical removal (see "Surgical Treatments
for Heel Pain").
While injury, overuse or other temporary, mechanical causes can bring
on discomfort in the heel, a painful heel may also accompany a more
serious condition, such as: · Gout
· Collagen disorders
· Nerve injuries
· Heel bone abnormalities
these and others must be diagnosed and treated separately. Your podiatric
surgeon may refer you to a local specialist if the problems are beyond
his or her area of expertise.
Caring for the
In most cases, heel pain can be relieved without surgery. Treatment
may include self-care, medications, therapy or orthotics.
Several steps can be taken to care for a painful heel at home. Take
medications that contain ibuprofen or aspirin daily as directed, for
as long as symptoms persist, to help reduce tissue inflammation.
Follow dosage directions
carefully. As with any medication, be aware of potential allergic responses
and discontinue use if any adverse reaction occurs, or if pain is not
relieved after several days' use. Soak the heel in ice water to relieve
pain and inflammation. This works best by placing the foot in a basin
filled with tap water, high enough to cover the heel. Allow the foot
to adjust to this temperature. Then add ice cubes (two or three at a
time) every five or six minutes over a 30-minute period. Soak the foot
in ice water three times daily and immediately after any activity. Heat
may also be recommended, but ice is usually preferable.
with diabetes or poor circulation should not use cold water or ice packs.
Avoid sports and other vigorous activities while healing. Wear higher
heeled shoes and choose shoes with heels made from soft rubber instead
of leather. Running shoes are often the most comfortable. Stretch the
calf muscles daily.
If self-care measures do not relieve the pain, the podiatric surgeon
may recommend various treatments to reduce inflammation. Some of these
may include: · Prescription oral nonsteroidal anti-inflammatory
medications to reduce both pain and inflammation. · Cortisone
injections · Foot taping and padding · Physical therapy
- The podiatrist or physical therapist may treat heel pain with ultrasound,
electrical stimulation or hydrotherapy. Each of these methods may help
reduce inflammation. · Custom orthotics - A foam or plastic orthotic
(custom-made to fit the foot) can often relieve the strain on the tissues
and permit the heel to recover.
for Heel Pain
If nonsurgical medical treatments fail and pain persists, surgical intervention
may be necessary. Both surgical procedures described below are usually
completed on an outpatient basis in less than one hour. They are performed
comfortably under either local anesthesia or minimal sedation administered
by trained personnel.
Removal of Connective
During surgery to separate all or a portion of the fascial tissue from
the heel bone, the podiatric surgeon will make a small incision on the
inside of the heel. Then, the tissue is carefully cut away (see illustration
A). A few stitches will be required.
Bone Spur Removal
Heel spurs may be removed during the same operation for separating the
connective tissue from the heel bone.
After the tissue
has been detached, the podiatric surgeon will remove any spurs, leaving
the heel bone smooth (see illustration B).
Immediately after either operator, a plaster cast may or may not be
used to support and immobilize the foot for two to three weeks. Crutches
may be helpful for greater comfort and mobility while the foot heals.
When the cast has
been removed, three to four weeks of physical therapy will speed healing
and reduce swelling. Provided there are no complications, recovery is
usually complete in six to eight weeks.
When Can Usual
Activities Be Resumed?
Normal daily activities can be gradually resumed as soon as pain subsides,
or when recommended by the podiatric surgeon. Within a few days after
surgery, most people begin moving comfortably. As recovery continues,
activities can gradually increase.
How Can Heel
Pain Be Prevented?
Unfortunately, prevention is not always possible. If pain is related
to too much activity or an abnormal foot structure (such as flat feet
or high arches), modifying the daily routine to exclude activities that
are stressful on the feet, should be considered. For example, jogging
should be replaced with biking and/or swimming. If symptoms of heel
pain develop, icing the foot should begin immediately. While these are
some of the most commonly prescribed treatments for heel disorders,
others may be used. The podiatric surgeon will determine which treatment
is likely to be the most successful in each case.
© 1997 The American College of Foot and Ankle Surgeons