Heel Pain

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Heel Spur / Bone Spur
Plantar Facilites
Pediatric Heel
Haglund’s Deformity

Heel Spur | Bone Spur

A bone spur (osteophyte) is a bony growth that forms along the edge of normal bone in response to wear and tear, most frequently in the joints. A heel spur is a bone spur of the heel bone, which causes heel pain by rubbing on the Achilles tendon or other soft tissues.

What causes a bone spur or heel spur?

When a bone is subjected to pressure, rubbing, or other stress over long periods, it tries to repair itself by building extra bone. This extra bone is what is referred to as a “spur”. Many form as part of the aging process when cartilage breaks down in the joints.

Bone spurs can form anywhere in the feet in response to tight ligaments, repetitive stress injuries (typically from sports), obesity, even poorly fitting shoes. For instance, when the plantar fascia on the bottom of the foot pulls repeatedly on the heel, the ligament becomes inflamed, causing plantar fasciitis. As the bone tries to mend itself, a bone spur forms on the bottom of the heel, typically referred to as a heel spur. This is a common source of heel pain.

Symptoms of a heel spur

Most heel spurs cause no symptoms and may go undetected for years. If they cause no pain or discomfort, they require no treatment. Occasionally, a bone spur will break off from the larger bone, becoming a “loose body”, floating in a joint or embedding itself in the lining of the joint. This can cause pain and intermittent locking of the joint. In the case of heel spurs, sharp pain and discomfort is felt on the bottom of the foot or heel.

Treatment of bone spurs and heel spurs

  • Rest
  • Ice
  • Over the counter pain medication (ibuprofen)
  • Change of footwear
  • Over the counter shoe inserts, padding, or heel cups
  • Custom foot orthotics
  • Weight management to take pressure off joints
  • Stretching exercises
  • Deep tissue massage via physical therapy
  • Steroid injections to reduce inflammation and pain
  • Surgery if conservative treatments fail to relieve pain

Plantar Fasciitis | Heel Pain

Plantar Fasciitis is an inflammation of the band of tissue (the plantar fascia) that connects the heel bone to the toes and supports the arch of your foot. It is the most common cause of heel pain in children and adults.

Plantar fasciitis is very common in runners, people who are overweight or obese, pregnant women, and those who wear shoes with inadequate support.

It’s believed that plantar fasciitis, and its associated heel pain or arch pain, is caused by the degeneration of the plantar fascia tissue, beginning with small tears that occur during activity. Under normal circumstances, these tears repair themselves when resting and sleeping, which strengthens the tissue. But sometimes the continued tissue damage overwhelms the body’s capacity to heal, small tears continue to accumulate, and the tissue begins to degenerate. Heel pain is the response.

Symptoms of plantar fasciitis

  • Pain on the bottom of the heel or arch
  • Pain upon awakening, decreasing with activity
  • Pain after a long period of standing
  • Pain that increases over a period of months

Causes of plantar fasciitis

  • Age – plantar fasciitis is most common in middle age
  • Overuse – playing sports, running, dancing, walking, or standing for long periods, especially on hard surfaces
  • Havingflat feet or overly high arches
  • Excessive pronation – your feet roll inward too much when walking
  • Being overweight or obese
  • Occupations that keep you on your feet
  • Shoes that don’t fit well, are worn-out, or don’t provide proper arch support
  • Wearing high heels too often may cause your Achilles tendon to shorten, putting strain on the plantar fascia

Treatment of plantar fasciitis

  • Rest
  • Ice
  • Stretching exercises
  • Physical therapy
  • Weight loss
  • Improving gait
  • Shoe modifications
  • Over the counter pain medications
  • Immobilization
  • Custom Molded Orthotics
  • Night splint
  • Steroid injections
  • Padding and strapping
  • Surgery when non-invasive treatments fail to relieve pain

 

HHHPediatric Heel Pain | Heel Pain In Children

Pediatric heel pain differs from heel pain experienced by adults, although they both are usually caused by plantar fasciitis (inflammation of the plantar fascia which connects the heel to the toes.

As adults, the symptoms of plantar fascitis usually occur in the morning when we get out of bed, and subside as we move around and the tissue warms up. Pediatric heel pain, generally speaking, doesn’t diminish as the child moves around – in fact it may get much worse.

Symptoms of heel pain in children:

  • Pain in the back or bottom of the child’s heel
  • Limping
  • Walking on the toes
  • Difficulty participating in normal activities or sports

Pediatric heel pain is very common due to the nature of a child’s growing feet. Between the ages of 8 and 14, the bones in a child’s foot grow faster than the tendons, and the heel bone (calcaneus) doesn’t fully develop until roughly 14. Until then new bone continues to form in the area of the growth plate, a relatively weak area at the back of the child’s heel. This uneven development means that the heel cord is relatively short compared to the leg bone, which causes the tendon to pull on the growth plate of the heel. When this pulling happens repeatedly, putting stress on the growth plate, heel pain results.

Because diagnosing heel pain in children can be a challenge, a podiatric surgeon is the best qualified medical professional to diagnose the underlying reason for the pain and to develop a treatment plan to alleviate the problem. Early intervention is extremely effective in correcting problems that may result in lifelong pain and discomfort.

 

Pediatric heel pain may be caused by the following conditions:

  • Overuse – The heel’s growth plate is frequently irritated by running and playing on hard surfaces. Children and young teens involved in soccer, track, or basketball are the most likely candidates to suffer from heel pain for this reason.Achilles Tendonitis  (inflammation of the achilles tendon) and plantar fasciitis are also frequent causes of heel pain in children.
  • Fractures – It’s common for a young child or teen to “tough it out” and dismiss the pain that comes with a stress fracture –a hairline break resulting from repeated stress on a bone. In children under ten, acute fractures can result from a jump as low as 2 or 3 feet. If a fracture doesn’t heal properly, arthritis will develop and the same area of the bone will be more likely to fracture again.
  • Sever’s Disease (calcaneal apophysitis) – This is the most common cause of heel pain in children. Pain results from an inflammation of the heel’s growth plate due to muscle strain and repetitive stress, especially in those children who are highly active or obese.
  • Tendo-achilles Bursitis – Injuries to the heel, diseases such as juvenile rheumatoid arthritis, or wearing shoes which don’t cushion the foot properly can cause an inflammation of the fluid-filled sac (bursa) between the achilles tendon and heel bone.

If your child complains about or exhibits any signs of weakness or pain in their feet, ankles, or lower legs, or exhibits a continued lack of coordination, please call our office for a thorough diagnosis. One of our podiatrists will examine your child to evaluate their condition and recommend a course of treatment.

A treatment plan to alleviate your child’s foot pain or heel pain may include:

  • Reducing activity to rest the irritated muscles, tendons, and/or ligaments
  • Custom molded orthotics to wear in-shoe to balance the foot correctly and cushion sensitive areas
  • Over the counter pain medications
  • Physical therapy to strengthen weak or injured areas of the foot and ankle
  • Immobilization
  • In severe cases,surgery may be required to lengthen a tendon or correct other problems

 

 

Haglund’s Deformity | Pump Bump | Bump On Heel

Haglund’s Deformity is a bony enlargement on the upper portion of the back of the heel bone. This enlargement, or “bump” of bone, may sometimes trap the soft tissue of the Achilles Tendon between the heel bone and the shoe resulting in irritation of the tendon, skin, and other soft tissue. Constant rubbing of the back of the shoe on this area can also lead to bursitis, an inflammation of the fluid-filled sac between the Achilles tendon and bone. The result is very significant heel pain.

Haglund’s deformity is nicknamed “pump bump”, because the rigid backs of pump-style shoes create pressure that aggravates the enlargement. In fact, the deformity is most common in young women who wear pumps, but may be created by any rigid shoe back, like men’s dress shoes or ice skates.

 

Symptoms of Haglund’s Deformity

  • Noticeable bump on the back of the heel
  • Pain and swelling in the area where the Achilles tendon attaches to the heel
  • Redness near the inflamed tissue
  • Tenderness in the back of the heel

 

Causes of Haglund’s Deformity

  • Heredity: The type of foot structure that makes you prone to developing Haglund’s Deformity is an inheritable trait
  • High arches: If you have a high arch, the heel bone tilts backward into the Achilles tendon where the tendon and bone connect. This causes the uppermost portion of the back of the heel bone to rub against the tendon. Eventually a bony protrusion develops and the bursa becomes inflamed
  • A tight Achilles tendon may cause pain by compressing the tender and inflamed bursa
  • A tendency to walk on the outside of the heel creates wear on the outer edge of the sole of the shoe. This in turn causes the heel to rotate inward, resulting in the grinding of the heel bone against the tendon
  • How to prevent Haglund’s Deformity
  • Wear appropriate shoes – avoid pumps, high-heeled shoes, and any rigid back shoes
  • Use arch supports or orthotic shoe inserts to balance the foot
  • Perform stretching exercises to keep the Achilles tendon loose
  • Avoid running on hard surfaces and running uphill

Treatment of Haglund’s Deformity

The inflammation of the bursa can be treated and reduced. However, this will not shrink the bony protrusion.

We recommend one or more of the following treatments to manage your heel pain from Haglund’s Deformity:

  • Anti-inflammatory medication to help reduce pain and inflammation
  • Ice – 20 minutes each hour
  • Physical therapy and stretching exercises to help relieve tension from the Achilles tendon
  • Heel lifts
  • Heel Pads
  • Shoe modifications
  • Custom molded orthotics to control motion in the foot
  • Immobilization is sometimes necessary to reduce symptoms

 

When Is Surgery Needed? 
If non-surgical treatment fails to provide adequate pain relief, surgery may be needed to relieve Haglund’s Deformity which focus on removal of the bump and possible lengthening of Achilles tendon and/or muscle.  Need to consult with our doctors for recommendations