Taking care of heel pain


Among all of the musculoskeletal complaints that patients have, heel pain accounts for about one percent of the total.

“When you think about how many bones, ligaments and joints there are in the body, that’s a significant number,” said podiatrist Benjamin Carelock, DPM, who recently joined Dr. Terry Cook to practice in Cortez.

According to Carelock, 2 million Americans suffer with heel pain every year, and over the course of a lifetime, we each have about a 10 percent chance of experiencing this aggravating condition. Of all foot problems, heel pain is responsible for 11 to 15 percent of those that require medical attention.

Having a little pain in the heel might not sound like major issue compared with the many serious and even fatal illnesses that can befall us. But when you’re the one suffering with that little heel pain, it can feel pretty major. Fortunately, the three main causes of heel pain – plantar fasciitis, stress fractures, and nerve issues – are largely manageable and treatable.

Factors that contribute to heel pain are inappropriate footwear, obesity, tight calves due to sitting or driving a lot, flat feet or a very high arch, and simply getting older.

“As we age, the fat pads around the heel thin,” said Carelock. Individuals who start a new activity or exercise program may experience the onset of heel pain, as can those who land a new job that requires standing for long periods of time.

If you begin to experience heel pain, there are several home remedies and lifestyle modifications to try.

“The first thing to look at is changing shoes,” said Carelock. If you’ve been bee-bopping around in flip-flops and start having heel pain, consider switching to a running shoe with good arch support. If that doesn’t solve the problem, try a high-quality over-the-counter arch support insert along with an over-the-counter anti-inflammatory medication. Gentle stretching and applying an ice pack might also help.

“If heel pain doesn’t resolve after trying these remedies for a few weeks, then see a podiatrist for an evaluation,” said Carelock.

Determining what is causing heel pain is not as straightforward as one might imagine, although there are some pretty good clues.

“The history of the course of the pain is the most telling thing,” said Carelock. “With plantar fasciitis, you usually have pain when you first get up and then feel better as the day goes on. If you have a stress fracture, the more you’re on it, the more it hurts. If heel pain is related to a nerve problem, it may be constant or hurt more when you’re at rest or trying to go to sleep.”

Knowing what’s causing the pain is the first step in a plan for treatment.

If pain is severe or comes on quickly, it’s worth being seen by a professional sooner rather than later.

“Getting treatment early, especially for plantar fasciitis, does lead to better results,” said Carelock. Plantar fasciitis occurs when the fibrous band of tissue that extends from the heel to the toes becomes inflamed.

Only about 10 percent of patients end up needing surgery for heel pain caused by plantar fasciitis. The vast majority improve over time (although sometimes it may take nine to 12 months) with noninvasive treatments including stretching, physical therapy, certain kinds of braces, applying ice packs and, in some cases, cortisone injections.

“In general, we only take patients to surgery if they’ve shown no improvement at all after six months of treatment,” said Carelock. When surgery is needed, it’s usually very successful.

Stress fractures – most common in runners – almost never require surgery. “Activity modification and sometimes a walking cast is usually the recommended treatment,” said Carelock. There is some early evidence that stress fractures may be more common in runners who wear the new “barefoot” type shoes, but this has not been confirmed.

If you remember the lyrics to the song from your childhood – “the hip bone’s connected to the thigh bone” – and so on, the fact that heel pain can be caused by a nerve in the back shouldn’t come as a surprise. A bulging disc in the lower spine can cause pain to radiate all the way down to the heel. “When a nerve issue is the cause of heel pain, we’ll frequently recommend physical therapy to help stabilize the lower back,” said Carelock. If that doesn’t yield positive results, patients may be referred to a neurologist for further evaluation and treatment.

To help prevent heel pain – and foot pain in general – Carelock recommends wearing good quality, supportive footwear that is appropriate for the activity you are involved in, maintaining a healthy weight, staying active, and keeping calf muscles flexible with regular stretching.

If you do suffer from heel pain, don’t hesitate to see a podiatrist. Treatments are effective and not terribly costly because lab work is almost never required, x-rays are only sometimes needed as part of the diagnostic workup, and expensive studies such as MRIs are rarely ordered. So don’t suffer needlessly if you’re having pain. Limp on over to your local podiatrist to get relief and get back to the activities you enjoy.

Southwest Health Notes is a public service feature provided by Southwest Memorial Hospital in Cortez. The information provided herein is not intended as patient-specific medical advice or as a substitute for consultation with your personal health-care provider.

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