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The heel is the workhorse of the foot–and on a certain level of the whole body. It’s tough and takes a lot of impact from everyday activities like walking and work tasks along with sports and other higher impact activities. But the heel also has a delicate side. Because it sees so much action, when it gets damaged (either by injury or overuse) it can cause a lot of pain. Here are some of the conditions that can cause heel pain and information about the best approaches to treatment.
Heel Pain: Calcaneus Fracture
What Is It?
The calcaneus is the medical name for the heel bone. It’s one of the seven tarsal bones that make up the midfoot and hindfoot. Fracturing a calcaneus bone is rare but can cause big problems when it happens. If you break your heel bone, the damage can range widely depending on several factors, including how many breaks have occurred, how big the bone fragments are and how badly those fragments are displaced. Another big factor is whether the joint just above the heel is broken at the same time. Your orthopaedist will use an X-ray or CT scan to get a better sense of the damage.
According to the American Academy of Orthopaedic Surgeons, there are three main causes of calcaneus fracture:
- Fall from a height
- Motor vehicle collision
- Twisting injury to the ankle
How Do We Treat It?
Treatment usually depends on how badly the pieces of bone have been displaced. If the bone fragments have not been displaced, your doctor may recommend immobilization with a cast, splint or brace for 6 to 8 weeks, with no weight-bearing on the foot while it heals. If bone fragments in the calcaneus have moved around, you may need surgery. The repair usually involves inserting special screws through a small incision or (if bone fragments are smaller) repositioning through a large incision and repairing with wires or metal plates and screws. According to the AAOS, full recovery can take anywhere from three months to a year depending on the severity of the break. Physical therapy can help patients regain strength and mobility whether or not surgery is required.
Heel Pain: Sever’s Disease
What Is It?
Sever’s Disease is a heel condition common in children and teens that happens when the growth plate in the calcaneus becomes inflamed causing pain at the back of the heel. Sever’s Disease is related to repetitive stress and usually happens during growth spurts, often in young athletes.
How Do We Treat It?
In most cases, Sever’s Disease is treated non-invasively. Your orthopaedist will usually recommend:
- Rest
- Limiting exercise (including taking a break from sports)
- Physical therapy or stretching and strengthening exercises
- Using a heel pad insert
- In some cases, changing footwear can help prevent a recurrence of Sever’s Disease
Heel Pain: Plantar Fasciitis
What Is It?
Plantar Fasciitis is one of the most common types of heel pain, with around 2 million people treated for plantar fasciitis each year according to the AAOS. Plantar Fasciitis happens at the bottom of the heel on the band of tissue that runs along the bottom of the foot from the heel to the toes (called the plantar fascia). The plantar fascia takes a lot of wear and tear, especially in athletes.
According to the Mayo Clinic, Plantar Fasciitis is often the result of repetitive motion causing small tears in the fascia tissue and is common in runners, people who wear shoes without enough support and people who are overweight. Certain types of exercise and work that keeps you on your feet can be risk factors, and studies have shown the condition may also be related to flat feet or high arches
How Do We Treat It?
Conservative treatment is often the best approach to treating Plantar Fasciitis and is effective in most cases. Some of the most effective non-invasive treatments include:
- Physical therapy
- A night splint that stretches your calf and arch as you sleep
- Orthotics, including custom fitted arch support
However, if the condition doesn’t respond to these treatments, your orthopaedist may recommend steroid injections or surgery to detach the plantar fascia from the heel bone.
Heel Pain: Bone Spurs
What Is It?
A heel spur happens when a calcium deposit causes a protrusion that looks like a spur on the bottom of the heel bone. Heel spurs are often connected with Plantar Fasciitis since the heel spur grows where the fascia attaches to the heel.
How Do We Treat It?
Treatment is usually similar to the recommended approach for Plantar Fasciitis, including:
- Stretching exercises or physical therapy
- Changing shoes
- Orthotics
- Night splints
In some cases, your orthopaedist may recommend surgery to remove the spur.
Physical Therapy and Heel Pain
One of the common threads with different types of heel pain is that physical therapy is an important component in treatment and recovery. This is the case whether or not surgery is required. Your heel plays such an important role in everything you do, from walking to sports, so regaining function and mobility after an injury is essential. Physical therapy is a valuable tool in speeding recovery and avoiding reinjury. Your physical therapist will focus on:
- Improving flexibility of the calf muscles, Achilles tendon and plantar fascia to prevent reinjury
- Implementing a supervised exercise program customized to your needs and condition
- Non-medical pain relief including ultrasound therapy and massage
At Countryside Orthopaedics, we’re foot specialists, orthopaedic surgeons and physical therapists with decades of experience in treating heel pain. We can take you through diagnosis and treatment, including surgery if needed, and accompany you on the road to recovery with a PT program designed to relieve pain and get you moving comfortably again.