You NEVER have to live with heel pain

by admin on March 3, 2013

The bottom of the heel.  Everyone has hurt their heel at some time in their life, usually from minor trauma like stepping on a rock or jumping down from a height.  For a few unlucky people, however, the bottom of the heel hurts constantly.  The heel is one of the few parts of the body that has  to carry the entire weight of the body for about a second per stride length.  That means that when the heel hurts, you feel it with every single step.  And for people with chronic heel pain, that translates into everyday misery.

To understand heel pain, we have to understand the  anatomy of the heel.  The skin under the heel is part of the sole, which along with the palms are the only place in the body with glabrous skin, the thicker, hairless, and more durable skin that in general is responsible for most of our touch sense.  It is not only stronger, but also more sensitive.  Beneath the skin of the heel is the fat pad, a layer of fat that is divided vertically by sheets of connective tissue to separate the individual globules into columns, much like the springs in a mattress.  Beneath the fat pad is a thick layer of connective tissue called the plantar fascia.  This band connects the heel with the ball of the foot, and is responsible in part for maintaining the arch.  HeelFinally, beneath the plantar fascia is the heel bone itself, called the calcaneus.  The calcaneus angles upward from the ground to meet the ankle bone on top and the rest of the foot ahead of it.  On the forward undersurface of the heel bone the muscles of the arch originate, protected by the plantar fascia, fat pad, and skin.  Additionally, as is true everywhere else, there is a network of small arteries, veins, and nerves in the area.  All of this together makes up the heel.

Anatomy is important because 9 times out of 10 heel pain is the result of a problem affecting one of these anatomic elements.  (The other 1/10 is heel pain due to sciatica or spinal arthritis.)  The problem most affecting the heel bone iteslf is a stress fracture of the calcaneus, which is typically a repetitive motion injury due to work or recreational activities such as jogging (stress fractures are not caused by traumatic injuries.)  Usually when dealing with heel pain you have an x-ray taken which typically will determine if you have a stress fracture or not.  X-rays of the heel often show heel spurs which I mention because common knowledge has it that heel spurs cause pain but this is generally not true.  Heel spurs can cause pain, but are very rarely the underlying cause and instead more of a contributor.  They are associated with the most common cause of heel pain, plantar fasciitis.  This inflammation of the plantar fascial band as it attaches to the bone causes a sharp, searing pain with weightbearing that gradually wears down with activity, only to strike again if you sit down to rest even just for a minute.  Plantar fasciitis can come on suddenly, but rarely leaves suddenly.  It tends to stick with people until they are able to get medical help, and because it is deep in the soft tissues you don’t see anything wrong, so often the problem has been around awhile before people finally make it in to the office.  Right in the same area, there is a nerve running between the heel bone and plantar fascial band that can become entrapped, causing its own unique version of pain and suffering that must be distinguished from plantar fasciitis.  To complicate things, this nerve is so small it cannot be tested with the usual nerve testing equipment, and usually its involvement can only be seen with the use of advanced imaging like ultrasound or MRI.  Finally, there can be bruising and injury to the fat pad of the heel that may feel like one of the above problems, and this is also a common area in the foot for benign tumors to form.  The potential diagnoses when you are dealing with heel pain are many and varied.

Well if the bad news is that diagnosis can be difficult, the good news is that treatment is comparatively easy.  To be exact, it is 99% successful.  Of all people who have heel pain and seek medical treatment, 90% resolve with conservative treatment; a fracture boot, anti-inflammatory pills, physical therapy, cortisone injection, heel padding.  10% go on to surgical treatment, of which 90% experience complete relief.   The bottom line is, YOU NEVER HAVE TO LIVE WITH HEEL PAIN.

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