With warm, summerlike weather already here, many of us have traded out our shoes for sandals or flip-flops. With the increase in activity for many, and the shift to a shoe type that provides less support, there can be an increase in foot problems. One of the most common types of foot problems is heel pain. One in 10 of the U.S. population that will suffer from heel pain at some point.  Though there are many causes, heel pain falls into five common diagnostic areas, according to Dr. Stephen L. Barrett of Innovative Neuropathy Treatment Institute in Phoenix.

 

 Dr. Stephen L. Barrett

Plantar fasciopathy or plantar fasciitis: More than 90 percent of the time of heel pain can be traced to an issue with the plantar fascia, a thick ligamentous type of tissue that runs from under the heel out toward the toes. It supports the arch.Though often called plantar fasciitis, that term can be misleading as in most cases the condition is degenerative and not inflammatory. As the plantar fascia degenerates, a heel spur may develop as a small offshoot of the heel bone (calcaneus). These spurs often are blamed for the pain. However, unless the spur is damaged, it does not cause the pain but is the body’s attempt to protect from pain. An ultrasound can determine if plantar fascia degeneration is causing your pain because the doctor can visually measure tissue changes objectively.

In mild cases, at simple changes like resting the foot, wearing proper, supportive shoes, or seeing your doctor about a good pair of orthotics may help ease the heel pain. In moderate to severe cases, your doctor can help determine if more intensive treatment is right for you. Several minimally invasive techniques have been developed that require little down time.

Medial calcaneal nerve entrapment:  The medial calcaneal nerve runs through small tight tunnels and can become entrapped causing heel pain. It is also possible that the nerve toward the inside and back of the ankle can be entrapped, commonly called tarsal tunnel syndrome. Different test can be used, in addition to good clinical evaluation for accurate diagnosis. If this condition is not treated early, it can become more difficult to treat as permanent nerve damage can occur.

Stress fracture of the heel bone: This condition is less common and occurs most often after a high-impact injury. These small fractures can be difficult to diagnose, but rest and staying off the foot usually heals the injury.

Achilles tendon: Heel pain caused by the Achilles tendon usually is toward the back of the heel and is often the result of overuse, combined with a congenital mechanical imbalance. Usually, the first line treatment includes proper stretching, especially before exercise, wearing proper, supportive foot gear, and sometimes a heel lift. In more severe cases, such as when there is severe degeneration of the tendon, surgery is often needed.

Heel fat pad disorder: Sometimes the fat pad that surrounds the heel and acts as a shock absorber, can wear down. This causes pain in the middle of the heel that gets worse when walking on hard surfaces or putting force on the heel with activities such as running. Properly fitting and padded shoes, or inserts designed to cushion the heel, can help, as well as over-the-counter medications, such as acetaminophen or ibuprofen, rest and ice.

To get the most accurate diagnosis and effective treatment, ask your board certified podiatric specialist for a diagnostic ultrasound on the first visit.