Heel & Bone Spurs

The Common Causes Of Heel Pain Can Continue Indefinitely If Untreated And Typically Become Progressively Worse. Troublesome Heel Pain Can Be Treated.

I. Heel Pain Has Many Causes

Pain, such as may occur in our heels, alerts us to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain.

a.) Heel Spurs

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.

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.

b.) Plantar Fasciitis

Both heel pain and heel spurs are frequently associated with aninflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and it can be quite painful.

The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.

The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that can accompany an athletic lifestyle.

Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.

c.) Excessive Pronation

Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.

As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward.

Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.

d.) Disease and Heel Pain

Some general health conditions can also bring about heel pain.

i.) 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.

ii.) An inflamed bursa (bursitis), a small, irritated sack of fluid; a neuroma (a nerve growth); or other soft-tissue growth can also call heel pain. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur.

iii.) 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.

Pain at the back of the heel is associated with inflammation of the achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. The inflammation is calledachilles tendinitis.

It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone.

This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.

iv.) Bone bruises are common heel injuries. A bone bruise orcontusion 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.

v.) Stress fractures of the heel bone also can occur, although infrequently.

vi.) Children’s Heel Pain occurs most commonly between ages 8 and 13, as children become increasingly active in sports activity in and out of school.

This physical activity, particularly jumping, inflames the growth centers of the heels; the more active the child, the more likely the condition will occur.

When the bones mature, the problems disappear and are not likely to recur. If heel pain occurs in this age group, podiatric care is necessary to protect the growing bone and to providepain relief.

Please call our Brentwood/Franklin or Nashville area podiatry office at 615.370.8880 if you have any additional questions and we will be happy to provide you with all the information that you may need.