Heel Pain

One of the most common problems Dr. Bishop sees is Heel pain. Heel pain is an extremely common condition with various potential causes. Understanding the underlying issue is essential for effective treatment.
Below is a detailed overview:

Common Causes of Heel Pain

Plantar Fasciitis

- Cause: Inflammation or microtears in the plantar fascia (a thick band of tissue connecting the heel to the toes).
- Symptoms: Sharp pain in the bottom of the heel, especially after rest or in the morning.
- Risk Factors: High-impact activities, obesity, tight calf muscles, flat feet, or high arches.

Heel Spurs

- Cause: Calcium deposits form on the heel bone, often associated with plantar fasciitis.
- Symptoms: Pain during weight-bearing activities, though not all spurs cause pain.

Achilles Tendinitis

- Cause: Overuse or degeneration of the Achilles tendon.
- Symptoms: Pain and stiffness at the back of the heel, often worse after activity.
- Risk Factors: Tight calf muscles, sudden increase in activity, flat feet.

Sever’s Disease (Calcaneal Apophysitis)

- Cause: Overuse injury in children and adolescents due to growth plate irritation.
- Symptoms: Heel pain, especially after physical activity.
- Risk Factors: Sports, rapid growth spurts.

Bursitis

- Cause: Inflammation of the bursa (a fluid-filled sac) at the back of the heel.
- Symptoms: Swelling, redness, and pain at the back of the heel.
- Risk Factors: Improper footwear or excessive pressure on the heel.

Stress Fractures

- Cause: Overuse or repetitive stress on the heel bone.
- Symptoms: Pain that worsens with activity and improves with rest.
- Risk Factors: High-impact sports, osteoporosis.

Tarsal Tunnel Syndrome

- Cause: Compression of the posterior tibial nerve near the heel.
- Symptoms: Burning or tingling pain in the heel or arch.

Fat Pad Atrophy

- Cause: Thinning of the protective fat pad under the heel.
- Symptoms: Deep, aching heel pain during weight-bearing activities.

Peripheral Neuropathy

- Cause: Nerve damage, often from diabetes or other systemic conditions.
- Symptoms: Burning, tingling, or numbness in the heel.

Treatment Options

Conservative Management

- Rest: Avoid activities that worsen pain.
- Ice Therapy: Apply ice packs for 15-20 minutes several times a day.
- Stretching and Strengthening:
1. Stretch the calf muscles and plantar fascia.
2. Strengthen foot muscles to support the arch.
- Orthotics: Custom or over-the-counter insoles for arch support and cushioning.
- Footwear: Use shoes with proper support and cushioning. Avoid high heels or flat shoes with inadequate support.
- Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation.

Physical Therapy

- Focuses on stretching, strengthening, and biomechanical correction.

Advanced Therapies

- Corticosteroid Injections: For severe inflammation (e.g., plantar fasciitis).
- Platelet-Rich Plasma (PRP): Promotes tissue healing for chronic conditions.
- Extracorporeal Shock Wave Therapy (ESWT): Stimulates tissue repair for conditions like plantar fasciitis or Achilles tendinitis.

Immobilization

- For stress fractures or severe pain, a walking boot or cast may be recommended.

Surgical Intervention

- Rarely needed but considered for:
1. Refractory plantar fasciitis (fasciotomy).
2. Removal of heel spurs causing nerve irritation.
3. Achilles tendon repair for significant tears.

Preventing Heel Pain

- Use proper footwear with adequate support.
- Stretch before and after physical activity.
- Gradually increase activity intensity to avoid overuse injuries.
- Maintain a healthy weight to reduce pressure on the heels.
- Strengthen foot and calf muscles for better biomechanics.

Finding a Specialist

If heel pain persists despite conservative treatment, consult Dr. Bishop at
480-342-999 for a thorough evaluation and personalized care plan.
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