HEEL PAIN
The rear foot consists of the heel of the foot. Basically, the heel bone (calcaneus), the Achilles tendon, and the plantar fascia are the most important parts of the rearfoot that provide structure and function to allow running. A large amount of stress from the ground hits the heel with every stride, so the heel is commonly injured in runners. Two major tissues, the plantar fascia and the Achilles tendon, are extremely important in foot mechanics to drive the leg forward with good strength and coordination, while absorbing stress from ground contact. Therefore, these 2 structures are most frequently injured.
PLANTAR FASCIITIS
WHAT IS IT?
Pain at the bottom of the foot at the heel.
WHY DOES IT HAPPEN?
More activity than the plantar fascia can handle. This can occur in new runners, or with increases in mileage, or can build up gradually over time.
SYMPTOMS
Heel pain with first step in the morning, which can progress to sharp pain with running or walking. The pain can be severe enough to change gait.
BEWARE
Other sources of similar pain can occur from stress fracture in the calcaneus (heel bone), trapped nerves in the heel, or skin growths. Click here for further information.
ACHILLES TENDINITIS
WHAT IS IT?
Pain in the Achilles tendon in the back of the heel.
WHY DOES IT HAPPEN?
Tissue failure occurs in the tendon from the demands of your training. This can occur in new runners, or with increases in mileage, or can build up gradually with no specific cause.
SYMPTOMS
Heel pain with first step in the morning, which can progress to sharp pain with running or walking. The pain can be severe enough to change gait.
BEWARE!
Other sources of similar pain can occur from stress fracture in the calcaneus (heel bone), trapped nerves in the heel, or skin growths.
HOW TO TREAT YOUR HEEL PAIN:
The basics—follow these steps:
- Confirm the diagnosis with your doctor. Plantar fasciitis and Achilles tendinitis can be treated similarly.
- Heal the injured tissue with rest, occasional ice/heat, stretching/strengthening, and treatments recommended by your doctor
- Once healed, prevent injuries with training modifications, core strengthening exercises, and clean living.
Your doctor may recommend the following depending on your diagnosis and the severity of your condition:
- A basic regimen of stretching/rest/ice/compression/elevation can help! Ask your doctor for specific instructions or a physical therapy
- Injections of “cortisone” (corticosteroid) may be offered for plantar fasciitis but has side effects and has not been shown to resolve the problem long-term. Never use “cortisone” injections for Achilles
- Shoe inserts such as orthotics, arch supports, or heel cups may be
- An external device (boot, cast, brace, or night splint) could help relieve heel
- Ask your doctor about new special procedures for stubborn cases of heel pain, such as PRP (platelet rich plasma) injections, tissue needling, myofascial release, and shockwave treatment.
- Surgery may be an option in extreme cases.
HEEL PAIN COMPLICATIONS: IT’S IN THE BONE!
Both Achilles tendinitis and plantar fasciitis can create bony overgrowths. The damaged tissue can cause a reaction over time at the insertion into the calcaneus heel bone in either condition. In Achilles tendinitis, the growth is called a Haglund’s deformity in the back of the heel, and in plantar fasciitis, bone spurs form on the bottom of the foot. Even though it’s the soft tissue causing the pain in both situations, the bony growths may be a complicating factor and surgery could be recommended at some point.
COULD IT BE SOMETHING ELSE?
For persistent pain despite treatments for a diagnosis of plantar fasciitis or Achilles tendinitis, return to your doctor for further evaluation. You may need to have further testing to look for other causes of heel pain:
- Stress fracture of the calcaneus (heel bone)
- Plantar nerve entrapment
- Posterior tibialis tendinitis (click)
- Tarsal tunnel syndrome (click)
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