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Managing Heel Pain
 Heel
pain is generally the result of faulty biomechanics (walking gait abnormalities)
that place too much stress on the heel bone and the soft tissues that attach to
it. The stress may also result from injury, or a bruise incurred while walking,
running, or jumping on hard surfaces; wearing poorly constructed footwear; or
being overweight.
The heel bone is the largest of the 26 bones in the human foot,
which also has 33 joints and a network of more than 100 tendons,
muscles, and ligaments.
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Conditions that cause heel pain generally fall into two main categories: pain
beneath the heel and pain behind the heel.
Centers such as pain management Los
Angeles centers can help to diagnose and treat both types of heel pain.
Pain beneath the heel
If it hurts under your heel, you may have one or more conditions that
inflame the tissues on the bottom of your foot:
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 Stone bruise: When you step on a hard object such as a rock or
stone, you can bruise the fat pad on the underside of your heel. It may or
may not look discolored. The pain goes away gradually with rest.
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Plantar fasciitis: (subcalcaneal pain) Doing too much running or
jumping can inflame the tissue band (fascia) connecting the heel bone to the
base of the toes. The pain is centered under your heel and may be mild at
first but flares up when you take your first steps after resting overnight.
You may need to do special exercises, take medication to reduce swelling and
wear a heel pad in your shoe.
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Heel spur: When plantar fasciitis continues for a long time, a
heel spur (calcium deposit) may form where the fascia tissue band connects
to your heel bone. Your doctor may take an X-ray to see the bony protrusion,
which can vary in size. Treatment is usually the same as for plantar
fasciitis: rest until the pain subsides, do special stretching exercises and
wear heel pad shoe inserts.
Pain behind the heel
If you have pain behind your heel, you may have inflamed the area where the
Achilles tendon inserts into the heel bone (retrocalcaneal bursitis). People
often get this by running too much or wearing shoes that rub or cut into the
back of the heel. Pain behind the heel may build slowly over time, causing the
skin to thicken, get red and swell. You might develop a bump on the back of your
heel that feels tender and warm to the touch. The pain flares up when you first
start an activity after resting. It often hurts too much to wear normal shoes.
You may need an X-ray to see if you also have a bone spur.
Initially, your doctor may instruct you to apply ice for 10 minutes several
times a day (especially after activity and at bedtime), using an ice bath or
cubes in a bag. If the problem persists he/she might prescribe painkillers, such
as aspirin or ibuprofen. Foam heel cups or shoe inserts (called orthotic
devices) may also be helpful.
Bathe your feet daily in lukewarm (not hot) water, using a mild
soap, preferably one containing moisturizers, or use a moisturizer
separately. Test the water temperature with your hand.
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In addition below are, stretching and strengthening exercises for the
Achilles tendon and the calf muscles that will help you heal faster. These
exercises are to be done barefoot.
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 Do
heel raises to help stretch and strengthen the Achilles tendon and the
plantar fascia .
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While
sitting on a chair, grab a towel with your toes as if you are going to pick
up the towel with your foot. Repeat this exercise several times a day.
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Strengthen
your leg muscles by standing on the ball of your foot at the edge of a step
and raising up as high as possible on your toes. Relax between toe raises
and let your heel fall a little lower than the edge of the step.
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Walk
on your toes only, then walk on your heels only, then walk backward to the
starting point. Carry hand weights (10 to 20 pounds) to increase the value
of these exercises.
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Stand
straight with your hands against a wall and one leg slightly behind your
other leg. Keeping your heels flat on the floor, slowly bend both knees. You
should feel the stretch in the lower part of your leg. Hold the stretch for
10 to 15 seconds. Repeat the stretch 6 to 8 times. This stretching exercise
may be helpful for plantar fasciitis, Achilles tendinitis and
calcaneal apophysitis.
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Lie down with your upper body supported on your elbows. Tighten the top
of the thigh muscle of one leg. Raise your leg on a count of 4, hold for a 2
count, and then lower the leg on a 4 count. Relax your thigh muscles. Then
tighten the thigh and repeat. Do 3 sets of 10 repetitions each day. Once
your leg gains strength, do the exercise with weights on your ankle. This
strengthening exercise may be particularly helpful for patellofemoral
syndrome.
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Lie
on your stomach. Tighten your thigh muscles and slowly raise your injured
leg off the floor on a 4 count. Hold the leg up for a 2 count, and then
lower the leg on a 4 count. Relax your thigh muscles. Tighten the thigh and
repeat. Do 3 sets of 10 repetitions each day. Once your leg gains strength,
do the exercise with weights on your ankle. This strengthening exercise may
be helpful for hamstring strain.
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Walk or run barefoot whenever possible.
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Practice stress reduction techniques to relax your muscles—and your
mind. These have been shown to help relieve pain. For instance, try tensing
and releasing the muscles in your body from your head to your toes.
As the pain decreases and your strength improves, gradually return to your
usual activities. Exercises that keep your full weight off your feet, such as
bicycling or swimming, will help you maintain fitness during recovery. Only a
relatively few cases of heel pain require more advanced treatments or surgery.
If surgery is necessary, it may involve the release of the plantar fascia,
removal of a spur, removal of a bursa, or removal of a neuroma or other
soft-tissue growth.
Dated 13 August 2012
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