Surprisingly, heel pain is a very common problem. By some estimates, one out of four Americans during their lifetime will experience at least one episode of heel pain severe enough to keep them off their feet and unable to do what they love for an extended period of time.

But just because a problem is common doesn’t mean it is normal. If heel pain is restricting your daily routine, regardless of your age or activity level, you need to have it examined by a podiatrist.

Dr. Thomas J. Bobrowski provides a comprehensive, effective treatment for even the most stubborn, chronic cases of heel pain. At InStride Crystal Coast Podiatry we not only treat the symptoms, but we also identify and treat the underlying cause in order to accelerate healing and prevent recurrence. In more than 9 out of 10 cases, heel pain can be resolved without surgical intervention.

What Causes Heel Pain?

Not all cases of heel pain are the same! There are several possible clinical diagnoses that can cause heel symptoms, and even though the diagnosis is the same, the underlying cause may be different.

Some of the most common heel pain conditions include:

  • Plantar fasciitis. Pain under the heel is caused by inflammation of a very thick ligament known as the plantar fascia. This fascia runs from the heel to the ball of the foot, acting as a strut to maintain the arch of the foot. This is usually an overuse injury resulting from wearing poor supportive shoes for the activities being performed or from a dramatic increase in activity level. You may find the pain to be sharpest right after getting out of bed in the morning or after sitting for an extended period and standing back up.
  • Heel spurs. Bony deposits can grow along the heel bone over time in response to chronic tension from the plantar fascia and Achilles tendon. They may or may not cause pain on their own, independent of the soft tissue injury.
  • Achilles tendon injuries. Inflammation, degeneration, or damage to the Achilles tendon at the back of the ankle and/or back of the heel.
  • Stress fractures. Under heavy, repetitive stress, hairline cracks may begin to form on the surface of the heel bone.
  • Sever’s disease / calcaneal apophysitis. This form of heel pain is exclusive to children and adolescents. At this age, the soft growth plate of the heel bone is vulnerable to injury and may become irritated from overuse.

Some of the underlying factors which strongly correlate to the onset of heel pain conditions include:

 

  • Wearing unsupportive, worn out, or ill-fitting footwear.
  • Tight Achilles tendon and calf muscle.
  • A dramatic increase in activity level such as starting a new sport or exercise routine or increasing your running or walking mileage.
  • Having hobbies or occupations that require a significant amount of standing or walking.
  • Having flat feet, high arches, or other structural foot issues which create inefficient foot mechanics.
  • Weight gain.
  • Physical trauma.

What Should I Do About My Heel Pain?

Step 1: Get It Checked

If your heel pain has lasted more than a few days and/or is keeping you from enjoying your daily activities or hobbies, you should seek our help. Quite often, we can resolve your pain using simple strategies—but in order to do that, we need to know what is causing your heel pain and why.

We will perform a thorough physical examination. This includes a digital X-ray to evaluate for heel spurs or possible stress fractures.

Step 2: Initial Treatment

For most patients, conservative treatment is more than adequate to eliminate heel pain.

In more severe cases, when the pain with initial weight bearing in the morning is unbearable, a cortisone injection may be recommended. It is important to understand that this injection will not “fix” the underlying cause of your heel pain. What it will do is provide a quick, significant reduction in your pain and inflammation, while we go about the work of healing your injury and removing the factors that caused it in the first place.

The extended course of treatment may include some of the following:

  • Heat therapy. By the time most patients come to see us, they have already been in pain for more than a few days. For this reason, heat is better than ice. If the heel is throbbing at the end of the day, a combination of heat and ice (contrast bath) is recommended.
  • A stretching program. Your calf muscle, Achilles tendon, heel bone, and plantar fascia are all connected as part of one functional unit. Tightness and pain in any of these structures can affect the others, including your heel. Stretching the Achilles tendon will gradually reduce tension on the heel and thereby reduce pain.
  • Instructions on shoe gear. We will take a close look at your shoes and make sure they are appropriate for your feet and for your activities. If not, we will recommend a shoe that will provide a supportive foundation for your feet.
  • Shoe supports. We carry a line of high-quality shoe inserts that provide significant heel pain relief for patients with mild-to-moderate symptoms. These devices give the foot structural support and can be adjusted to further balance the foot, alleviating the strain on the plantar fascia and Achilles tendon. Don’t make the mistake of simply buying “orthotics” at the pharmacy. These inserts are designed for cushioning instead of support, and at best will only provide temporary relief. For more severe cases of heel pain prescription orthotics may be recommended.
  • Behavior modifications. Depending on the underlying causes of your heel pain, we may provide additional advice on matters such as how to exercise safely, protect your heels at work, etc.

    As previously stated, these treatments are often all that is required for lasting relief.

Step 3: The Follow-Up

Unfortunately, in some cases, heel pain can persist despite initial attempts to relieve it.

If you continue to experience more discomfort than you were expecting a month after your initial appointment, we may need to modify your treatment plan or recommend additional modalities such as:

  • Stretching splints to more aggressively stretch the Achilles tendon and fascia
  • Physical therapy
  • Custom orthotics
  • Oral or Topical anti-inflammatories

In our experience, the majority of heel pain conditions can be effectively treated within three months of the initial visit. Less than 10 percent of cases require a surgical solution—and the earlier you seek professional help after the onset of symptoms, the better your odds are of resolving the pain quickly and without surgery.

Step 4: Keeping the Pain Away

Once your heel pain subsides, it is important to continue treating the underlying cause and to follow the instructions given by our team to prevent recurrence.

It is relatively common for people to slide back into their old habits and routines after their heel pain has resolved, and this often leads to recurrence. To prevent this, we recommend that you continue wearing good shoes with the supports or orthotics and avoid walking around in bare feet or flip flops for extended periods of time.

Don’t let heel pain continue to dictate your lifestyle and your activities. For effective, comprehensive treatment, contact Dr. Thomas J. Bobrowski and the team at InStride Crystal Coast Podiatry today. You can reach our office in New Bern at (252) 638-4700, or online by completing our contact form.