Heel pain is one of the most common foot complaints. During walking a pressure equivalant to body weight and running a pressure twice of body weight is exerted on heel while running. Considering the time that we stand and walk on heels, heel pain can be very devastating. It is a commonly believed that a calcaneal spur causes the heel pain, however, it is responsible only in 10 % of cases. A heel spur can be seen in most of the elder and in middle age overweight patients, yet not being the cause of the heel pain in most cases.
First, the area pain felt is evaluated thoroughly. Pain at the bottom of the heel is usually due to plantar fasciitis, calcaneal spur, hypoplasia of heel fat pad, and nerve entrapment.
Plantar fascia is band shape fibrous tissue starting from heel bone to the front part of the sole. Recuurent traumas, walking overtime, strenuous sportive activities, using unproperly fitted shoes may cause inflammation of plantar fascia. The pain in plantar fascia is felt in the morning and standing upright position after prolonged rest position. Pain increases when the patient gets tired. Patients feel better in high heel shoes.
In calcaneal spar disease pain at the bottom is felt as if something is sticking.
Nerve innervating foot splits in two branches around ankle and later it gives another branch which innervates the muscle located in the lateral part of the sole. Entrapment of this nerve also causes pain mostly at the inner, medial side of the heel.
Pain felt behind the heel at the posterior ankle part is generally secondary to Achilles tendinosis, calcaneal spurs, and Haglund Disease. They may be developed due to long distance running, playing tennis and racketball, overtraining. It could be also an anatomical variation.
Stretching exercises, heel supports and anti-inflammatory medication are very effective in most cases. If symptoms are persistant, then further investigation is required for prompt diagnosis. Treatment alternatives are ESWT, Physical Theraphy, pain manegement drugs, and surgery deepnding on the underlying cause.
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