Heel Pain

  • Plantar Fasciitis And Shoewear
    Proper footwear is crucial not only in the prevention of foot and toe problems but also in treating these problems.  A comfortable, properly-fitted shoe can help in preventing a toe joint problem from returning after surgery, relieving pain in the foot or toe or preventing a foot or toe problem from developing or getting worse. 

    You can develop a foot or toe problem such as a bunionplantar fasciitis, callus or hammertoe for a number of reasons, but your footwear can play a large role in how bad your foot condition becomes.  

    Try these tips when shopping for your next pair of shoes:

    -Stand up while getting fitted for your shoe and walk around the store to make sure the shoe fit feels right.
    -Shoe size, especially width can change with age, so have both of your feet measured  when buying new shoes.
    -If you have orthotics or shoe inserts, make sure you bring them when trying on new shoes.
    -Try on shoes at the end of the day when your feet are at their largest due to normal swelling.
    -If a shoe feels snug, ask the salesperson to stretch it out for you.  With that said, you should not have to break in shoes if they fit properly.

    The type of shoe selected is vital for maintaining a healthy foot.  Make sure you pick a shoe that laces up as opposed to slips on and has a flexible sole that allows your toes to bend as you walk.  Avoid high heeled, narrow or pointed-toe shoes, as these increase pressure on the front of your foot and on the toe joints.  If you must wear heels, selects shoes that are no more than 2 inches high.  Shoes that breathe when your feet sweat are best so avoid plastic or vinyl shoes.  Look for a shoe with a wide and deep toe box that allow you to wiggle your toes while they are in the shoe and avoid shoes with seams, as they may rub against or irritate the skin around your foot problem.  

    When you are at home, wear sandals, soft-leather flat shoes or slippers or even go barefoot if possible. 

    Be sure to discuss all of the above tips with us before shopping for new footwear.  We will be able to offer you our recommendations depending on your specific needs.  

  • Pain In The Bottom Of The Foot And Heel Region

    There are several causes of pain in the arch of the foot and heel region. The type of pain and its location help the doctor in determining the cause of the pain and helps to direct them in the best treatment for the patient

    The most common pain in the bottom of the foot is heel pain. This pain tends to be worse first thing in the morning or after rest. It is associated with a tight ligament in the bottom of the foot called the plantar fascia. X-rays will often reveal a spur on the bottom of the heel. (See plantar fascists and heel spurs)

    Pain in the back of the heel can be due to bony enlargements (Hagland's deformity), spurring in the Achilles tendon or Achilles tendonitis.

    Burning pain in the bottom of the foot may be caused by a condition called tarsal tunnel syndrome or it may be due to peripheral neuropathy. People with diabetes frequently experience burning in the bottom of the feet.

    Pain in the middle of the arch of the foot that is also associated with small, hard knots may be due to plantar fibromatosis.

  • Pain In The Back Of The Heel

    The common cause of a painful bump on the back of the heel is called Hagland's deformity. This is due to an enlarged bony prominence on the back of the heel. It can involve the entire back of the heel or just a portion of the back of the heel, usually on the outside portion of the heel. Also called the Pump Bump, it is most common in women and is frequently a result of pressure from the back of the shoe. As the shoe rubs on the back of the heel bone it begins to swell and enlarge. Quite often a bursa will form. A bursa is a sack that is created over any bony prominence when excessive pressure or friction to the areas occurs. Bursae can be filled with a thick watery like fluid.

    Treatment

    Treatment consists of removing the pressure and avoiding shoes that rub on the back of the heel. Orthotics, custom molded shoe inserts, can be useful because they reduce the rocking motion side-to-side of the heel while walking which aggravates the painful area. Cortisone injections can temporarily reduce the pain or eliminate the pain. Surgery can be the treatment of choice if other means to reduce the pressure are unsuccessful.

    Spurring in the Achilles tendon

    Closely related to Hagland's deformity is an enlargement that can occur on the back of the heel that is a result of the formation of a large spur where the Achilles tendon attaches. Treatment is the same as with the Hagland's deformity except that the surgical procedure to remove the spurring is more complex and has a longer recovery period.

    Achilles Tendonitis

    Swelling and lumps can also occur in the Achilles tendon just above its attachment into the heel bone. Termed Achilles tendonitis, this occurs when there is a tear in the tendon. If this goes untreated the tendon is at risk of rupturing. Treatment consists of immobilization with a cast, possibly crutches to take weight off the foot, oral anti-inflammatory drugs and if severe surgery may be necessary. Once the area is healed aggressive physical therapy and calf muscle stretching exercises may be needed. There is another small tendon that attaches in the back of the heel that can become injured. It is called the Plantaris tendon. This tendon can tear or rupture during exercise. It is associated with a sudden onset of pain during exercise and mimics Achilles tendonitis.

    An Uncommon Cause - Xanthomas

    An uncommon cause of small lumps in the Achilles tendon is an excessively high cholesterol level in the blood stream. This is a hereditary disorder that results in the deposition of cholesterol in the Achilles tendon. This is a serious condition and requires aggressive treatment by a physician to lower the cholesterol levels. Left untreated the high cholesterol levels can lead to premature heart attack and death.

  • Pain In The Arch Of The Foot And Heel Region

    There are several causes of pain in the arch of the foot and heel region. The type of pain and its location help the doctor in determining the cause of the pain and helps to direct them in the best treatment for the patient.

    The most common pain in the bottom of the foot is heel pain. This pain tends to be worse first thing in the morning or after rest. It is associated with a tight ligament in the bottom of the foot called the plantar fascia. X-rays will often reveal a spur on the bottom of the heel. (See plantar fasciitis and heel spurs) Pain in the back of the heel can be due to bony enlargements (Hagland's deformity), spurring in the Achilles tendon or Achilles tendonitis. Burning pain in the bottom of the foot may be caused by a condition called tarsal tunnel syndrome or it may be due to peripheral neuropathy. People with diabetes frequently experience burning in the bottom of the feet. Pain in the middle of the arch of the foot that is also associated with small, hard knots may be due to plantar fibromatosis.

  • Painful Bumps On The Back Of The Heel

    The common cause of a painful bump on the back of the heel is called Hagland's deformity. This is due to an enlarged bony prominence on the back of the heel. It can involve the entire back of the heel or just a portion of the back of the heel, usually on the outside portion of the heel. Also called the Pump Bump, it is most common in women and is frequently a result of pressure from the back of the shoe. As the shoe rubs on the back of the heel bone it begins to swell and enlarge. Quite often a bursa will form. A bursa is sack that is created over any bony promance when excessive pressure or friction to the areas occurs. Bursa can be filled with a thick watery like fluid.

    Treatment of Hagland's Deformity and Pump Bumps

    Treatment consists of removing the pressure and avoiding shoes, which rub on the back of the heel. Orthotics, custom molded shoe inserts, can be useful because they reduce the rocking motion side-to-side of the heel while walking which aggravates the painful area. Cortisone injections can temporarily reduce the pain or eliminate the pain. Surgery can be the treatment of choice if other means to reduce the pressure are unsuccessful.

    Spurring in the Achilles tendon

    Closely related to Hagland's deformity is an enlargement that can occur on the back of the heel that is a result of the formation of a large spur where the Achilles tendon attaches. Treatment is the same as with the Hagland's deformity except that the surgical procedure to remove the spurring is more complex and has a longer recovery period.

    Achilles Tendonitis

    Swelling and lumps can also occur in the Achilles tendon just above its attachment into the heel bone. Termed Achilles tendonitis, this occurs when there is a tear in the tendon. If this goes untreated the tendon is at risk of rupturing. Treatment consists of immobilization with a cast, possibly crutches to take weight off the foot, oral anti-inflammatory drugs and if severe of surgery. Once the area is healed aggressive physical therapy and calf muscle stretching exercises. There is another small tendon that attaches in the back of the heel that can become injured. It is called the Plantaris tendon. This tendon can tear or rupture during exercise. It is associated with a sudden onset of pain during exercise and mimics Achilles tendonitis.

    An Uncommon Cause - Xanthomas

    An uncommon cause of small lumps in the Achilles tendon, called Xanthomas, are due to an excessively high cholesterol level in the blood stream. This is a hereditary disorder that results in the deposition of cholesterol in the Achilles tendon. This is a serious condition and requires aggressive treatment by a physician to lower the cholesterol levels. Left untreated the high cholesterol levels can lead to premature heart attach and death.

  • Morning Heel Pain

    Do you have heel pain when you initially get out of bed in the morning?  Pain experienced with the first few steps in the morning is often a symptom of plantar fasciitis.  The term used to describe this symptom is post static dyskenisia.  This is very common for people suffering from plantar fascitiis and can easily be alleviated. 

    Plantar fasciitis is not the only cause of morning stiffness or heel pain but it is one of the most common.  There are many reasons for morning heel pain and morning stiffness, however one of the most common is attributed to microscopic tearing of the plantar fascia which occurs when one initially takes their first steps after a night of rest. 

    While sleeping, the mechanical tension is reduced on the plantar fascia and Achilles tendon and the fascia has a chance to begin the reparative process. When one steps out of bed, the inflammatory cycle is often initiated and pain is experienced.  Normally, the pain begins to subside with more walking, however, it usually returns again towards the end of the day and always returns again overnight.  Stretching of the Achilles complex and plantar fascia can often greatly reduce this pain.

    If you are experiencing pain when you initially get out of bed in the morning, please contact us for an appointment.   

  • Lumps And Bumps On The Bottom Of The Foot

    There are a number of different causes of lumps and bumps on the bottom of the foot. Working from the toes to the heel:

    1. Lumps and Bumps on the Bottom of the Big Toe

    A painful lump may be found on the bottom of the big toe. This condition often presents itself as a hard callused area. Sometimes a hard lump may be felt beneath the callused area. The most common cause of this condition is a limitation of movement of the big toe joint while walking. If there is limitation of movement at this joint, then the big toe cannot bend upward as the heel comes off the ground while walking. As a consequence, there is excessive force placed on the bottom of the big toe and an enlargement of the bone in this area will occur secondary to the pressure. Another cause is the presence of an extra bone or piece of cartilage in the area. However, it is the limitation of movement in the big toe joint that causes the area to become enlarged and painful.

    People who have diabetes must watch these areas closely. Over time, the excessive pressure can cause this area to break down and ulcerate. One way to check to see if there is a limitation of movement of the big toe joint is to perform the following test. While standing on a flat surface, have another person try to bend the big toe upward. The joint that must move is the joint where the toe attaches to the foot. There is a joint in the middle of the big toe and this is not the one you are checking. If the big toe joint cannot be bent upward then a limitation of motion exists. Testing the movement at the joint without putting weight on the foot will give a false impression as to the available movement at the joint while you are walking. This limitation of movement of the big toe while walking can, over, time create an arthritic condition in the joint. A bony mass may then form on the top of this joint as a result of jamming in the joint. This condition is called hallux limitus or hallux rigidus. Treatment for the painful lesion in the bottom of the big toe joint consists of using functional foot orthosis to correct the functional limitation of the big toe joint motion or may consist of surgical correction of the hallux limitus. Rarely is surgery to remove only the lesion on the bottom of the toe alone, successful, because the cause of the initial problem still exists.

    2. Lumps and Bumps in the Ball of the Foot

    Painful lumps in the ball of the foot are usually but not always associated with a thickening of the skin or callus. These areas are due to a prominence of the long bone behind the toe called the metatarsal bone. When there is a mal-alignment of these bones, one or more of them may become propionate. When this occurs, the weight-bearing force across the bottom of the foot is disturbed. Weight is not evenly distributed across the ball of the foot, and these areas absorb greater pressure. The excessive pressure often forms a callus or thickening of the skin. People who have diabetes should watch these areas carefully. Over time, they can ulcerate the skin and can become infected. Treatment consists of removing the pressure with pads or using a molded insole or orthotic in the shoes.

    Other skin lesions that frequently occur on the bottom of the foot are plantar warts, porokeratoses, and inclusion cysts.

    3. Lumps and Bumps in the Arch of the Foot- Plantar Fibromas

    Within the arch of the foot, firm, nodular masses may form. These can occur as a single mass or in clusters. They are called plantar fibromas and are a non-cancerous tumor that forms within a ligament in the arch of the foot called the plantar fascia. Frequently, they will slowly enlarge causing pain while walking. Their cause cannot always be determined. Damage to the tendon will cause their occurrence and there is an association with taking the drug Dilantin. In 10% of the cases, patients will also demonstrate similar lumps in the palms of the hands called Dupuytren's Contracture. Treatment consists of padding the area to reduce pressure. Functional foot orthotics will take the strain off of the plantar fascia ligament and sometimes cause the fibromas to shrink in size. Cortisone injections are of little value and may even stimulate the mass to enlarge or spread. Surgical excision of the mass requires removal of most of the plantar fascia. Simple excision of the mass without removal of the entire ligament generally results in recurrence of the mass. Whenever surgery is contemplated, the patient should wear a functional foot orthotic following the surgery. The orthotic helps to accommodate for the loss of the plantar fascia and its effect on foot function (See surgical excision of plantar fibromas).

  • Extracorporeal Shockwave Treatment

    What is ESWT?

    Extracorporeal shockwave treatment, also known as ESWT, is a non-invasive, non-surgical treatment option for the intense, persistent heel pain associated with chronic plantar fasciitis and achilles tendonitis. "Extracorporeal" means "outside the body." Shockwaves, also known as pressure or sound waves, are generated from a special ESWT device and focused onto the targeted tissue. The shockwaves are delivered outside the body to trigger an individual's own repair mechanisms. The concept behind shockwave therapy in orthopedic disorders is that the shockwave stimulates and reactivates healing to encourage revascularization and other elements necessary to advance normal tissue healing. Additionally, shockwaves help to over-stimulate pain transmission nerves, which can lead to a reduction in sensitivity and pain.

    What is plantar fasciitis?

    The plantar fascia is a band of connective tissue on the plantar surface of the heel that plays a large role in maintaining the normal architecture of one's foot. Plantar fasciitis is a common clinical condition caused by overuse or injury of the plantar fascia and is defined as traction degeneration of the plantar fascial band at its origin on the medial tubercle of the calcaneus. Inflammation, fibrosis and decreased vascularization of the fascia occur, causing symptoms of heel pain. Other symptoms that may occur include burning in the sole of the foot, recurring foot pain that is especially aching in the morning or after sitting or heel pain after beginning a new exercise routine.

    What causes plantar fasciitis?

    There are a number of predisposing factors, including foot pronation, obesity, poor fitting shoes, minor trauma, occupational risks and change in exercise program. Although everyone is at risk, plantar fasciitis is most commonly found in athletes, runners, overweight individuals or those who are required to stand on hard surfaces for prolonged periods of time. Although approximately 2,000,000 Americans suffer from plantar fasciitis, ESWT is an appropriate treatment option in approximately 5 to 10% of those cases, as the remainder of the cases can be adequately addressed with more conservative therapies.

    Who should receive ESWT for plantar fasciitis?

    Prior to undergoing ESWT treatment, the patient must have been diagnosed with chronic plantar fasciitis for at least six months. Only after the patient's symptoms fail to respond to three conservative treatments should ESWT be administered. Conservative treatments include rest, physical therapy, heel cushions, non-steroidal anti-inflammatory drugs (ibuprofen, acetaminophen, etc.), cortisone injections, taping, orthotics, shoe modifications, night splinting and casting. In years past, surgical intervention for chronic plantar fasciitis was required when these other treatments had failed. Today, ESWT is available as an alternative, non-invasive treatment option.

    Who should not receive ESWT treatment for plantar fasciitis?

    Your health history should be reviewed with your doctor to see if this treatment is appropriate for you. ESWT is not recommended for patients with certain conditions. Patients with pacemakers and patients taking medications that may prolong or interfere with blood clotting (coumadin) are not candidates for ESWT. Also, children or pregnant women are not considered appropriate candidates for ESWT. ESWT is not appropriate for individuals suffering from acute plantar fasciitis.

    What are the side effects of ESWT?

    Compared to surgery, ESWT has fewer side effects and a much shorter recovery time. The most common patient complaint is some minor pain or discomfort during and after treatment. Other side effects might include minor skin bruising, reddening or swelling of the treated area. However, these possible occurrences usually resolve within a few days. The risks associated with surgery and general anesthesia are eliminated.

  • Posterior Tibial Tendon Dysfunction (PTTD)
    Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch, which results in flattening of the foot.  PTTD is often referred to as "adult acquired flatfoot" because it is the most common type of flatfoot developed during adulthood.  PTTD is normally caused by overuse of the posterior tibial tendon, which is commonly found in those that participate in physical activities such as running, walking, hiking or climbing stairs.  The symptoms of PTTD can include redness, swelling, pain, flattening of the arch and an inward rolling of the ankle.  The symptoms can change as the condition progresses.  There are many treatment options available for PTTD, including orthotics, physical therapy, medications, shoe modifications and immobilization.  Occasionally, surgery is required.
  • Heel Pain: Heel Spurs
    Heel spurs are growths of bone that extends from the heel bone.  The spurs themselves have no feeling, but they extend from the heel bone into the soft tissue surrounding the bottom of the foot, causing inflammation and pain. They are commonly characterized by a sharp poking which is localized to the heel or underneath the heel.  The pain can become very severe and bruising may occur in some cases.  Pain is found to most commonly occur after prolonged periods of rest, when taking a step or when putting pressure on the heel.  In most cases, heel spurs occur in individual over the age of 40 due to sudden weight gain, improperly fitted shoewear, pronation, gout and rheumatoid arthritis.  There are many treatment options for heel spurs, such as heel pads, arch supports, orthotic therapy and anti-inflammatory medications. In some cases, surgery is recommended.