is a very challenging problem as it can be local and/or referred. It has been more
prevalent recently due to the hard grounds on which people have to run. Commonly people will present with heel pain, thrusting an x-ray at you, and being adamant that the problem is a heel spur. This
is defined as a small bone that grows from the heel, directing forwards towards the toes. This may be as small as 1 mm to anything as large as 8 - 10 mm. Most of the time, this is an incidental
finding, as there many heels that are pain free that have heel spurs evident on x-rays. The spur is thought to be a result of traction of the plantar fascia on the heel. In some cases, the spur may
contribute to the symptoms, but is not the main cause. This should be explained very carefully to the patient, as the focus on the spur may limit the recovery, as the patient may believe that the
only way to eliminate the pain is to remove the spur.
Achilles tendon rupture, the tendon of the heel cord behind the ankle is torn. Bone bruise. Bone cyst, a solitary fluid-filled cyst (cavity) in a bone. Gout, levels of uric acid in the blood rise
until the level becomes excessive (hyperuricemia), causing urate crystals to build up around the joints. This causes inflammation and severe pain when a gout attack happens. Neuroma (Morton's
neuroma) a swollen nerve in the ball of the foot, commonly between the base of the second and third toes. Osteomyelitis , osteomyelitis means infection of the bone or bone marrow; inflammation of the
bone due to infection. Osteomyelitis sometimes occurs as a complication of injury or surgery. In some cases, the infection may get into bone tissue from the bloodstream. Patients with osteomyelitis
typically experience deep pain and muscle spasms in the inflammation area, as well as fever. Peripheral neuropathy, neuropathy is a collection of disorders that occurs when nerves of the peripheral
nervous system (the part of the nervous system outside of the brain and spinal cord) are damaged. The condition is generally referred to as peripheral neuropathy, and it is most commonly due to
damage to nerve axons. Neuropathy usually causes pain and numbness in the hands and feet. It can result from traumatic injuries, infections, metabolic disorders and exposure to toxins. One of the
most common causes of neuropathy is diabetes. Problems with your gait, wrong posture when walking/running. Rheumatoid arthritis, rheumatoid arthritis, sometimes referred to as rheumatoid disease, is
a chronic (long lasting), progressive and disabling auto-immune disease condition that causes inflammation and pain in the joints, the tissue around the joints, and other organs in the human body.
Rheumatoid arthritis usually affects the joints in the hands and feet first, but any joint may become affected. Patients with rheumatoid arthritis commonly have stiff joints and feel generally unwell
The most common complaint is pain and stiffness in the bottom of the heel. Heel pain may be sharp or dull, and it may develop slowly over time or suddenly after intense activity. The pain is
typically worse in the morning, when taking your first steps of the day. After standing or sitting for a while. When climbing stairs.
The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present
and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.
Non Surgical Treatment
Calf stretch, Heel cups/lifts, ice, night splint, physical therapy, activity modification. Sometimes immobilization in a cast or boot may be necessary. Topical creams, such as Voltaren or Ketoprofen,
have been found to have some benefit. In some cases, the tendon may become degenerative (tendonosis). In these instances, treatment is more difficult. Prolonged periods of immobilization and physical
therapy may be required. In resistant cases, surgical debridement of the tendon may be necessary. Rarely does a symptomatic achilles tendon rupture. Most achilles ruptures are not associated with
prodromal symptoms. Achilles ruptures are more common in men and "weekend warriors," ie middle aged men who like to play sports (soccer, softball, basketball) on the weekends.
If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles
and joints or a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely
affecting their career. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your
plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as open surgery, where the section of the plantar fascia is released by making a
cut into your heel or endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia.
Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A
disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open
surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery,
plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and
disadvantages of both techniques with your surgical team.
Heel pain is commonly caused from shoes that do not fit properly. In addition, shoes need to have ample cushioning and support, particularly through the heel, ball of the foot, and arch. Shoes should
also be replaced if they become too worn. One sure sign of wear and tear is overly worn areas of a shoe's insoles. If the heel or ball of the foot is particularly worn, damage could easily occur
since the bottom of the foot is not getting the cushioning it needs.