Heel Pain Is Never Normal
Pain is never normal and should not be treated as a small, unimportant problem. The body’s defenses are built around pain to let the brain know that something is wrong. Heel pain is no different. In fact, heel pain can be an indication of serious injury after a fall (calcaneal fractures), can be an indication of a growth plate inflammation in active children (Severs Disease or calcaneal apophysitis), can be an indication of overuse injuries in someone exercising (stress fractures), can be an indication of nerve compressions in injury (Baxter’s Neuritis or Tarsal Tunnel), can be an indication of tendon injury (Achilles tendonitis, Achilles tendon tears, Achilles bursitis or Posterior Tibial tendonitis or tears), can be an indication of bone abnormalities (Haglund’s Deformity, calcaneal spurs or bone cysts or tumors) and can be an indication of a torn or inflamed plantar fascia (plantar fasciitis or plantar fascial tear). Should any of these problems really go untreated? What if the problem is more serious than the initial diagnosis?
Over the years and in the literature, it has been determined that a proper diagnosis and treatment requires a complete physical exam including careful evaluation of the involved nerves of the area, x-rays to ensure no significant bony abnormality, ultrasound to evaluate soft tissue structures including tendons and ligaments (including the plantar fascia), and careful evaluation of gait patterns for possible walking abnormalities.
Heel Pain is Often Linked to How a Person Walks
The most common influence on many of the problems that lead to heel pain is how an individual walks. Although walking or gait patterns are inherited, every individual body will react differently to the gait abnormalities and can lead to stresses that cause pain. For example, why does one athletic child get heel pain while another never experiences it? This even happens in families. The biggest difference is always their exact walking pattern.
- Does the individual have a high arch or a low arch? Weightbearing arch height is not always the same as non-weightbearing.
- Does the patient walk intoed (pigeon-toed), outtoed or rectus (strait)?
- What is the alignment of the leg on the foot?
- Is there a leg length discrepancy (is one leg shorter than the other)? This can be a true leg length difference, or the legs may just function like one is shorter than the other.
- Is there appropriate coordination of supination and pronation? Does the individual stay supinated or over-pronate?
- How does the foot function throughout gait?
- Is there appropriate coordination of muscles or is there muscle weakness? Is there stiffness or rigidity to tendons or joints?
- Is ambulation painful? Is the gait pattern consistent with accommodation for a problem?
- Are there balance concerns? Bent over gait, wide base of gait, short or choppy steps.
- Are there neurological concerns? Shuffle gait, difficulty walking, weakness, short or choppy steps.
Evaluation of the gait pattern can always indicate what is happening through the walking process that produces heel pain. It usually will provide methods not to just treat the pain and improve it, but prevent it in the future. As the heel pain is treated, resolved and prevented, other problems can also be prevented in the future. This prevention may be the biggest reason for treating heel pain.
Heel Pain Can Lead to Problems Elsewhere
As with many problems in the foot, heel pain is often caused by how an individual walks, but will also change the way one walks over time. One of our defense mechanisms is pain, so we will physically adjust the way we walk to limit pain. Are you now putting increased pressure on the ankle, knee, hip or back? Is the other leg and foot taking all the pressure? Are you stressing the other tendons of the foot, changing pressure points to the outside of the foot or the toes? Any of these changes can ultimately produce injuries or long-term problems in other parts of the foot, ankle, knee or back. These other problems are often more serious and take longer to treat than “simple” heel pain. Over years, injuries from the changes in walking can even lead to surgeries that could have been completely prevented with early treatment of the heel pain. Don’t let heel pain become something more serious.
Whatever the cause of heel pain, without treatment it will not resolve. Sometimes the simple at home treatments will help including ibuprofen or other anti-inflammatories, ice, rolling on a tennis ball (golf ball or water bottle), stretching, over-the-counter inserts (or orthotics), changes in shoes, limiting walking and standing or changing activities. But often the treatments only reduce or stop the pain for a period of time. Wouldn’t it be better to solve the problem long-term through proper evaluation and treatment. Let’s keep everyone active and keep heel pain from stopping them from doing what they love or more importantly what is important to their health.