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Heel Pain
 
Heel pain may be due to many conditions, such as a stress fracture, tendonitis, arthritis, nerve irritation, Plantar Fasciitis or, a bone spur. Because there are several potential causes, it is important to have heel pain properly diagnosed. East Penn Foot and Ankle Associates are well trained to distinguish between all the possibilities and determine the underlying source of your heel pain.
Plantar Fasciitis - Pediatric Heel Pain - Haglund's Deformity
Plantar Fasciitis
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes.
Symptoms
- Pain on the bottom of the heel or arch
- Pain that is usually worse upon arising
- Pain that increases over a period of months
- Pain with first step in the morning or after rest
- Pain decrease with activity
Causes
The most common cause of plantar fasciitis relates to faulty structure of the foot such as overly flat feet or high-arched feet.
Overuse syndrome such as wearing non-supportive footwear on hard, flat surfaces for prolong periods puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis.
Obesity also contributes to plantar fasciitis.
Diagnosis
To arrive at a diagnosis, East Penn Foot and Ankle Associates will obtain a thorough medical history and examine your foot.
Diagnostic imaging studies such as x-rays, a bone scan, or magnetic resonance imaging (MRI) or Ultrasound may be used to distinguish the different types of heel pain.
Treatment
- Stretching exercises
- Avoid going barefoot
- Ice
- Shoe modifications
- Medications
- Lose weight
- Padding and strapping
- Orthotic Devices
- Injection therapy
- Removable walking cast
- Night splint - Can be purchased at our online store
- Physical Therapy - Rehabilitation program with Robbins Rehabilitaion
Although most patients with plantar fasciitis respond to non-surgical treatment, if after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered
Long-Term Care
For all patients, wearing supportive shoes and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
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Pediatric Heel Pain
Heel pain is a warning sign that a child has a condition that deserves attention. Heel pain in children is often caused by injury to the growth plate commonly referred to as Calcaneal Apophysitis or Sever’s Disease. A growth plate is an area of growing tissue within the bone that determines the future length and shape of the bone. Growth plate injuries of the heel are usually caused by overuse. However, pediatric heel pain may be the sign of many other problems, and can occur at younger or older ages.
Symptoms
- Pain in the back or bottom of the heel
- Limping
- Walking on the toes
- Difficulty participating in normal activities or sports
Why Does Pediatric Heel Pain Differ From Adult Heel Pain?
During these ages (8 to 14 years old), the bones are growing faster than the tendons. This means that the heel cord is relatively short when compared to the leg bone, causing the tendon to pull on the growth plate of the heel. When this is the case, a great deal of tension is put on the heel bone causing irritation and pain. Also, during this time frame the bone is still immature and is more prone to injury.
Pediatric heel pain usually does not improve with activity. In fact, walking around typically makes the pain worse. Where adult heel pain improves with activity.
Causes
- Calcaneal Apophysitis is heel pain in children caused by injury to the growth plate in the heel bone
- Tendo-Achilles Bursitis - Inflammation of the fluid-filled sac (bursa) located between the Achilles tendon (heel cord) and the heel bone. Can be associated with certain diseases such as juvenile rheumatoid arthritis
- Overuse Syndrome
- Fractures - Sometimes heel pain is caused by a break in the bone such as Stress Fractures
Diagnosis
To diagnose the underlying cause of your child's heel pain, East Penn Foot and Ankle Associates will first obtain a thorough medical history and ask questions about recent activities. A thoruogh examine of the child's foot and leg. X-rays are often used to evaluate the condition, and in some cases the surgeon will order a bone scan, a magnetic resonance imaging (MRI) study, or a computerized tomography (CT or CAT) scan. Laboratory testing may also be ordered to help diagnose other less prevalent causes of pediatric heel pain.
Treatment
- Reduce activity
- Cushion the heel
- Medications - Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
- Physical Therapy - Rehabilitation program with Robbins Rehabilitaion
- Custom Foot Orthotic Devices
- Immobilization
- Surgery - There are some instances when surgery may be required to lengthen the tendon or correct other problems
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Haglund's Deformity
Haglund’s deformity is a bony enlargement on the back of the heel that most often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone). In Haglund’s deformity, the soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes.
Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, the deformity is most common in young women who wear pumps.
Symptoms
- A noticeable bump on the back of the heel
- Pain in the area where the Achilles tendon attaches to the heel
- Swelling in the back of the heel
- Redness near the inflamed tissue
Causes
- Heredity may play a role in Haglund’s deformity. People can inherit a type of foot structure that makes them prone to developing this condition.
- High arches can contribute to Haglund’s deformity. The Achilles tendon attaches to the back of the heel bone, and in a person with high arches, the heel bone is tilted backward into the Achilles tendon. This causes the uppermost portion of the back of the heel bone to rub against the tendon. Eventually, due to this constant irritation, a bony protrusion develops and the bursa becomes inflamed. It is the inflamed bursa that produces the redness and swelling associated with Haglund’s deformity.
- Tight Achilles tendon, causing pain by compressing the tender and inflamed bursa. In contrast, a tendon that is more flexible results in less pressure against the painful bursa.
Diagnosis
- X-Rays will be ordered to help us evaluate the structure of the heel bone
- MRI or Ultrasound may also be ordered if further evaluation is needed
Treatment
The goal is to reduce the inflammation of the bursa. While these approaches can resolve the bursitis, they will not shrink the boney protrusion.
Non-Surgical Approaches:
- Medication - Anti-inflammatory medications may help reduce the pain and inflammation
- Ice - 20 minutes of each waking hour. Do not put ice directly against the skin
- Exercises - Stretching exercises help relieve tension from the Achilles tendon
- Heel lifts
- Heel Pads
- Shoe Modifications
- Physical Therapy - Rehabilitation program with Robbins Rehabilitaion
- Orthotic devices - These custom arch supports are helpful because they control the motion in the foot, which can aggravate symptoms
- Immobilization - In some cases, casting may be necessary to reduce symptoms
When Is Surgery Needed?
If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. The foot and ankle surgeon will determine the procedure that is best suited to your case. It is important to follow the surgeon’s instructions for post-surgical care.
Prevention
- Wearing appropriate shoes; avoid pumps and high-heeled shoes
- Using arch supports or orthotic devices
- Performing stretching exercises to prevent the Achilles tendon from tightening
- Avoiding running on hard surfaces and running uphill
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