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. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet.
There are many potential causes of heel pain and Dr. Simmons has been trained to distinguish between them to determine the underlying source of your heel pain and prescribe the best treatment program to help you.
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.
In our pursuit of healthy bodies, pain can be an enemy. In some instances, however, it is of biological benefit. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we’ve suffered.
Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.
The most common form of heel pain occurs on the bottom of the heel. It tends worsen when first placing weight on the foot. Patients often complain of pain the first thing in the morning or after getting up to stand after sitting. The pain can be a sharp, searing pain or present as a tearing feeling in the bottom of the heel.
A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as “heel spur syndrome.”
Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.
Some general health conditions can also bring about heel pain.
- Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint, can cause heel discomfort in some cases.
- Haglund’s deformity (“pump bump”) is a bone enlargement at the back of the heel bone, in the area where the achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe.
- Bone bruises are common heel injuries. A bone bruise or contusion is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.
- Calcaneal apophysitis is often referred to as “Sever’s Disease” although it is not a true “disease.” It is a painful inflammation of the heel’s growth plate. It typically affects children between the ages of 8 and 14 years old and can occur in one or both feet, because the heel bone (calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate, a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop.
Problems that affect the Achilles tendon include tendonitis, tendinopathy, tendocalcaneal bursitis, and tendonosis. These problems affect athletes most often, especially runners, basketball players, and anyone engaged in jumping sports. They are also common among middle-aged adults. These problems cause pain at the back of the calf.
The Achilles tendon is a strong, fibrous band that connects the calf muscle to the heel. When combined with the calf muscles, they help you sprint, jump, or climb.
A violent strain can cause trauma to the calf muscles or the Achilles tendon. Sometimes this is referred to as tendonitis. This injury can happen during a strong contraction of the muscle, as when running or sprinting. Landing on the ground after a jump can force the foot upward, also causing injury. The strain can affect different portions of the muscles or tendon. Severe cases may result in a rupture of the Achilles tendon.