For Immediate Release Contact: Melanie Shivers
06/02/11 205-599-3804

Feeling Out of Step?
Heel pain has many causes
By William H. Burkhalter III, MD

Birmingham, AL – We’ve all heard the expression about walking a mile in someone else’s shoes – and, considering the amount of time spent on our feet, those miles can add up. According to the American Academy of Orthopaedic Surgeons, every mile we walk places 60 tons of stress on each foot. It’s not surprising that many of us develop foot problems.

The most common ailment affecting the foot and ankle area is heel pain. Heel pain has many causes: overuse (such as a heavy amount of running or other high-impact exercise, or standing for long periods of time); an injury to the bottom of the foot; being overweight; or anatomical problems (such as flat feet or a very high arch). Other possible causes include arthritis, osteoporosis, tendonitis, a stress fracture, nerve irritation, or a cyst.

Heel pain occurs in two areas: pain beneath the heel and pain behind the heel. Pain beneath the heel happens after a strain or injury to the tissues underneath the foot. Some common causes are a stone bruise, a heel spur, and plantar fasciitis.

A stone bruise is the result of stepping on a hard or sharp object, bruising the fat pad underneath your heel. As we age and lose the cushiony tissue in certain areas, they cannot absorb as much shock from walking or sports activity.

Plantar fasciitis refers to inflammation of the band of tissue on the bottom of the foot that stretches from the heel to the toes. This type of injury also occurs more often as we age, or become less active, and tissue becomes less flexible. However, the most common cause of plantar fasciitis is the structure of the foot itself; people with very high arches or flat feet are particularly prone to plantar fasciitis. Symptoms include pain on the bottom of the heel, pain that worsens when you stand, and pain that increases over time (weeks and months) instead of improving. If plantar fasciitis persists over a long period of time, a calcium deposit (also known as a heel spur) can form where the tissue connects to your heel bone.

Pain behind the heel is frequently due to inflammation of the area where the Achilles tendon attaches to the heel bone. Overuse – running too much – or wearing shoes that don’t fit well and rub the back of the heel often causes pain. Typically, pain increases gradually, along with thickened, red and swollen skin at the site of inflammation, and a bone spur may develop. You may notice pain at night or while you are resting, or pain that flares when you first start an activity after being still (i.e., walking or running after long periods of being seated). Sometimes the pain is so intense that you are unable to wear shoes. You can alleviate the pain by wearing open back shoes, using a heel lift, taking over-the-counter pain medication, and doing certain foot stretches.

Some foot pain can be treated at home with simple remedies, including:

· Over-the-counter pain medication, such as acetaminophen, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs)

· Applying ice to the heel area for 20 minutes, several times a day, to reduce inflammation

· Performing certain stretching exercises that promote flexibility in calf muscles and the Achilles heel area

· Wearing supportive shoes with a good arch support, or wearing a heel insert in your shoe (also called orthotics) to cushion the area and correct any anatomical issues such as arch problems

· Avoid going barefoot

A doctor who specializes in the care and treatment of foot disorders can diagnose the source of heel pain and design a treatment plan. This might be a podiatrist, an orthopedic doctor, a rheumatologist (who specializes in joint/muscle pain and arthritis), or a foot and ankle surgeon. If lifestyle modifications, stretching exercises and pain medication do not bring relief, your doctor may recommend wearing splints or taping your foot at night for stability, corticosteroid injections or, in a few cases, surgery.

To learn more, visit www.trinitymedicalonline.com click on “Health Resources,” “Interactive Tools,” and “Quizzes,” to take the “Foot Health Quiz” or our “Osteoporosis Quiz.”

About the author: William H. Burkhalter, III, MD, practices Primary Care Sports Medicine. He is a member of the Trinity Medical Center Medical Staff and his office is located in Trussville.

Remember that this information is not intended to replace the advice of your doctor, but rather to increase awareness and help equip patients with information and facilitate conversations with your physician that will benefit your health.

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Sources: American Association of Orthopedic Surgeons www.aaos.org; American Association of Family Physicians www.aap.org