Heel Pain Overview
Do you have heel pain? Is it painful when you get up and step out of bed? Do you get a sharp pain in the bottom of the heel whenever you get up out of a chair and start to walk? If so, chances are good that you are suffering from painful inflammation of a large ligament on the bottom of your foot. This condition is know as plantar fasciitis.
Most people with plantar fasciitis will get better with simple treatments and without significantly interrupting their work or exercise routines. If you have plantar fasciitis and need to know how to do the stretching exercises to get better, see the three instructional videos we have uploaded here.
You can also request a free copy of Dr. Segler's book No More Heel Pain; A Guide to Understanding Heel Pain Causes and Treatments.
What Causes Heel Pain?
Pain is the body's way of telling us that we may have suffered an injury or contracted an illness. Pain that occurs in our heels alerts us to seek medical attention. Because a variety of causes exist for heel pain, it is very important to have any type of heel pain properly diagnosed by a podiatrist.
The heel bone is the largest of the 26 bones found in the human foot. The foot also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. The heel bone is subject to a variety of outside influences that can affect its ability to function properly. Symptoms of heel pain that should be treated by a podiatrist include pain on the bottom of the heel or the back of the heel, pain that worsens upon rising, and pain that increases in severity over a period of months. The most common causes of heel pain on the bottom of the foot are plantar fasciitis, heel spurs, and tarsal tunnel syndrome. The most common causes of posterior heel pain or pain behind the heel are Achilles Tendonitis, heel bursitis, and heel bumps. We'll discuss each of these now.
This is the most common cause of heel pain on the bottom of the foot and is an inflammation in the band of tissue (the plantar fascia) that runs from the heel to the toes. This condition is most often caused by poor foot structure such as overly flat feet or high arches. It can also be caused by wearing non-supportive footwear on hard surfaces, spending long hours on your feet, or obesity. The pain from plantar fasciitis is usually a sharp, stabbing pain on the inside of the bottom of the heel that can feel like a knife sticking into your heel. Pain from plantar fasciitis is usually most severe when you first stand on your feet in the morning. It will usually subside, but can return with prolonged standing or walking or getting up after long periods of sitting. Because this is by far the most common cause of heel pain, most of the information on this site is directed at plantar fasciitis. The other causes are addressed in more depth in NO MORE HEEL PAIN; A GUIDE TO UNDERSTANDING HEEL PAIN CAUSES AND TREATMENTS. This book is now available.
Sometimes heels spurs are found in people with plantar fasciitis, but they are rarely the source of pain. Heel spurs are bony growths on the underside of the heel bone caused by tension from a tight plantar fascia ligament. They result from strain on the muscles and ligaments of the foot, stretching of the plantar fascia, and repeated tearing away of the lining or membrane that covers the heel bone. Close to 70% of patients with plantar fasciitis have a heel spur that can be seen on an X-ray. Plantar fasciitis and heel spurs are often confused and they are related, but they are not the same condition.
TARSAL TUNNEL SYNDROME
The tarsal tunnel is a tight space in the foot that lies between bones and tough fibrous tissue. A nerve called the posterior tibial nerve lies within the tarsal tunnel. If this nerve becomes compressed or squeezed, tarsal tunnel syndrome can result. Symptoms include numbness over the bottom of the foot and/or pain, burning and tingling over the base of the foot and heel. Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.
The Achilles tendon is named for Achilles, the Greek mythology hero, who was vulnerable only at his heel. The Achilles tendon is the largest tendon (a band of tissue that connects muscle to bone) in the human body and is very strong, but is also the tendon we most often rupture. Everyone who is active can suffer from Achilles Tendonitis, a common overuse injury and inflammation of the tendon. Symptoms of Achilles tendonitis include mild pain after exercise or running that gradually worsens, a noticeable sense of sluggishness in your leg, and episodes of diffuse or localized pain, sometimes severe, along the tendon during or a few hours after activity. Symptoms also include tenderness, or sometimes intense pain, when the sides of the tendon are squeezed. Other symptoms can be swelling, morning tenderness in the Achilles tendon, or stiffness that generally diminishes as the tendon warms up with use.
There are several fluid-filled sacs behind the heel bone that act as a cushion and a lubricant between muscles and tendons sliding over bone. They are known as bursa. Repetitive or over use of the ankle can cause the bursa to become inflamed or irritated leading to heel bursitis. The condition is often mistaken for Achilles Tendonitis. Symptoms include pain in the heel, especially when walking, running, or jumping or when the area is touched. The skin around the back of the heel may be red and warm to the touch, and the pain may worsen when standing on tiptoe. It is commonly seen in people who are just starting an aggressive exercise routine.
Also known as Haglund’s Deformity (or “pump bumps”), heel bumps are a bone enlargement on the back of the heel bone. These usually occur for athletes when the shoes they wear rub up against the heel, and they can be aggravated by the height or stitching of a heel counter of a particular shoe. The result is a painful bump or bumps on the heel that make exercising very difficult. Another term used for this condition is pump bump because it can frequently occur with the wearing of high heels as well.
The most frequent source of heel pain in children between the ages of 9 and 15 is Sever's Disease. It is caused by an inflammation of growing plates in the back of the heel due to rapid bone growth and is most often seen in children who participate in athletics. With this condition pain is usually felt at the back and side of the heel bone or even the bottom of the heel. Pain usually worsens when the heel bone is squeezed or when the child is running or jumping. Podiatrists are trained to treat patients of all ages and it is important to have your child examined if they are complaining of heel pain or limping.
How Can I Treat Heel Pain?
1. Achilles Tendon Stretches are essential to eliminate your heel pain. Perform the stretches as illustrated under the section on stretching. There are also video demonstrations as well. Do the stretches twice-a-day; morning and evening.
2. Icing your heel is vital to decrease inflammation that accumulates while you walk during the day, and to prevent more inflammation while you sleep. You can either use a frozen bfamily size bag of peas (which will conform t the contours of your heel) or you can purchase a specialized gel cold pack called a SoleStep. The SoleStep is more convenient than a bag of peas, but honestly, both are effective. You can get peas at the grocery store. The SoleStep is available online. Wear your SoleStep at the end of the day! Use your SoleStep by taking it out of the freezer and wearing it on your painful heel for 15-30 minutes just prior to bedtime, Remove the SoleStep and place back in the freezer just before you go to bed so it will be ready for the next night.
3. A Night Splint is a device that holds your foot and ankle in a correcting position while you sleep. Wear your Night Splint on the painful foot while you sleep. Do not walk on the splint. Remove the night splint before you begin walking in the morning. You can find a selection of night splints at Fit Feet, our healthy shoe store right next to our office. If you prefer to shop online you can find one online and it will be shipped right to your home.
4. Do not go barefoot. Do not wear flip-flops or house shoes while recovering. Only wear shoes with a moderate heel that do not bend through the arch. Always wear shoes when walking, even in the home. This is critical to decrease strain on the plantar fascia and allow it to heal. Wear Custom Orthotics or any of our recommended semi-custom inserts in your shoes at all times. Semi-custom inserts are available with your free digital foot scan and pressure analysis at Fit FEET, our healthy shoe store.
5. Perform ABC’s after any period of inactivity to decrease pain with initial step. Simply hold you leg straight and then move your foot in order to spell the entire alphabet in the air with your big toe. This will help to loosen up your plantar fascia and decrease inflammation before you step on the foot and cause pain in your heel. Do this whenevre rising in the morning or sitting for long periods such as when working at a computer.
We have a very high success rate with these treatments. Less than 1% of patients who follow these treatments will need surgery to become pain free!
You can download the instruction sheet for plantar fasciitis treatment I give to patients in case you have misplaced it.
Do Orthotics or Shoe Inserts Help?
Both custom orthotics and semi-custom arch supports can help and are important to speed your recovery. These devices are removable inserts that go in your shoes in place of the footbeds that come in the shoes when you purchase them.
We have many types available at Fit Feet, our healthy shoe store. Our helpful staff can hlep you determine which type will be best for your foot type. In addition, you can get a free foot scan to evaluate your foot structure. There is no appointment necessary and there is no charge for the digital foot scan and pressure analysis. If you need custom orthotics we offer an unheard of money-back-guarantee on our Perfect Form custom orthotics.
In order to get the very best support and fastest recovery, you will need an appointment with Dr. Segler. He will perform a full exam to evaluate your condition, foot type, and need for custom ortotics. If medically necessary, he will make cast impressions of your feet in order to custom build your orthotics. Like eyeglasses, these are custom to you and will only help you.
If you wear the right types of shoes and control the abnormal motion that leads to plantar fasciitis, you will back to running through Golden Gate Park, hiking in the Marin Headlands, or strolling through the Marina district...all with a focus on fun instead of heel pain.
Show Me the Heel Pain Stretches!
If you have been diagnosed with plantar fasciitis there are many stretching exercises that can get rid of your heel pain and get you back on the road.
The most effective stretch is illustrated in this handout. To perform this stretch, stand upright about one large pace away from the wall with your feet parallel and about shoulder width apart. Keep your feet in line as shown. Place your hands against the wall, at shoulder height. Move your right leg half a pace forward. Lunge forward on your right leg so that the knee is brought directly above the ankle. Stretch your left leg back as far as is comfortable with the foot and heel remaining flat on the floor. Slowly lean forward to stretch the left leg calf muscles and tendon. Hold the stretch for 10 seconds, relax, and repeat on the other leg.
This stretching routine is extremely effective and will only take 1 minute in the morning and 1 minute at night. Try to do the stretches whenever you brush your teeth so that you do it consistently. You can expect for your plantar fasciitis to gradually get better over several weeks.
We also have 3 different video demonstrations available to show you how to perform several stretches and get the fastest recovery. To see the stretching demonstration videos, click on the "video" section.
What Shoes Do I Need if I Have Plantar Fasciitis?
First and foremost, you need shoes that support your feet to relieve the strain on the plantar fascia. You should wear shoes that have a moderte hel and do NOT bend in the arch. You should never go barefoot while recovering, even when in the home. If you wear flip flops, they must have a moderate heel and built in arch support. All of this was explained by Dr. Segler in an article on flip-flops in the Times-Free Press.
Make sure you wear sandals or flip flops that have built in arch support. We have several choices available through our online store to meet this need. If you like to wear flip-flops, you can wear these while you are recovering.
You can also wear Crocs, but we recommend Medical-Grade Crocs. They have better materials and better support than standard versions available in most stores.
If you have flat feet, fallen arches, or suffer from over-pronation, it is critical that you support the arch and decrease the pronation that stresses and damages the plantar fascia. You can click on our recommended shoe list to see what types of shoes you need. Many of these are widely available at shoe stores as well.
If you wear the right types of shoes and control the abnormal motion that leads to plantar fasciitis, you will back to running, hiking, or walking...all with a focus on fun instead of heel pain.
What is Extra Corporeal Shockwave Therapy (ESWT)?
Extracorporeal Shock Wave Therapy treatments use high-power sound waves to end chronic heel pain without painful surgery. This treatment is now being offered by our office as an alternative to heel surgery. The discovery of ESWT came about somewhat by accident. Shock wave therapy is used regularly by urologists to break up and disperse kidney stones. Urologists began reporting that patients who had kidney stones treated showed increased bone density and new tissue growth. This led to studies for using shock wave therapy for soft tissue injuries and the results were amazing—75%-80% of patients with soft tissue injuries were reported to be healed or greatly improved following ESWT.
Shock wave therapy works by purposely targeting trauma at the pain site. This stimulates the diseased tissue and activates your body’s own healing process. Blood and oxygen rush to the site, activating a metabolic response that fosters healing by the growth of new connective tissue. This is what is damaged and torn when you have plantar fasciitis or heel spur pain. The most important and exciting aspects of ESWT are that it ends the pain, the procedure is not painful, there isn’t a lengthy recovery period, and there are no side effects.
What is APC Therapy?
Autologous Platelet Concentrate (APC) Therapy is a new treatment for chronic plantar fascitis. This is not for everybody with heel pain. It is a new cutting edge treatment and is only for those who have been diagnosed with plantar fasciitis that has not repsonded to other treatments.
This is not surgery. Is a minimally invasive treatment that utilizes your body's own cells and healing potential to dramatically reverse the chronic inflammation that causes plantar fasciitis.
APC Therapy is an advanced procedure that is performed to stimulate healing. A small sample of blood is drawn from the patient, spun in a centrifuge, and the platelets (the growth and healing factors of the blood) are drawn out afterwards. After the platelets are drawn out, they are re-injected into the damaged tissue in the plantar fascia. This stimulates healing at a rate of 5,000 times more quickly than the healing rate of normal blood vessels.
This breaks up the cycle of chronic inflammation. The injured tissue then repairs itself and prevents the need for surgery.
When this procedure is done there are no stitches and no significant risks like those in surgery. There is no need to travel to or wait in the hospital to have this performed. This procedure is performed right in our office treatment room at a time that is convenient for you.
FREE Heel Pain Book
WHY I WROTE THIS BOOK
NO MORE HEEL PAIN: A GUIDE TO UNDERSTANDING HEEL PAIN CAUSES AND TREATMENTS
Congratulations on your choice to become informed about heel pain! If you or someone you care about suffers from heel pain this FREE guide may be the most useful piece of literature you read this year. We have written this guide so that the vast majority of patients can empower themselves with the knowledge to end heel pain once and for all. Now you can look forward to starting your morning with healthy pain-free steps. No more limping out of bed with pain as a wake-up call!
This guide has been written with one simple idea in mind…empower people to stop limping because of a simple, easily treatable common condition. In my practice as a foot and ankle surgeon at the Ankle & Foot Center I have seen patients with heel pain every day. What I have realized is that most of these patients (probably just like you) could get better without ever seeing a doctor. That’s right…without ever seeing a doctor.
I have realized that all most patients really need is a simple understanding of the causes and conditions that lead to chronic heel pain and the power to treat it themselves. With that end in mind, this guide has been prepared so that you can understand what causes heel pain and how you can make it go away…forever.
Based on the results I have seen among my patients at the Ankle & Foot Center, 98-99% of heel pain sufferers reading this guide will be able to effectively self-treat their heel pain and get permanent relief without every visiting a doctor and without spending hundreds or thousands of dollars on doctor visits, custom inserts, elaborate devices or expensive shoes. The reason I know this to be true is that I have tracked the progress of those patients that have been seen in my office.
My treatment philosophy and practice style is simple. I firmly believe that simple, reliable, cost-effective treatments should always be attempted before expensive and evasive treatments like surgery. Although I am an award winning foot and ankle surgeon (and admittedly love doing surgery) I truly believe that surgery is just a bad idea if any other treatment will work.
The reasons why surgery should always be a last resort is easy to understand:
1.Once you have surgery the rules change...other treatments are less likely to work.
2.All surgery has risks including pain, bleeding, infection, scarring, etc.
3.You can always have surgery later, after other treatments have failed.
4.There are only 2 guarantees with any surgery…
a. I can guarantee you will get a scar.
b. I can guarantee you will receive a bill.
There is NO guarantee that you will be pain-free or even much better off.
So, if you are one of those who think that surgery will probably be needed to get rid of heel pain…think again. I often have patients who come to our office and inquire about heel surgery on the very first visit. When this happens I usually end up spending about 45 minutes to an hour explaining why surgery is a bad idea. Next I explain how they can get better without surgery. This guide was created so all of these people (much like you) can get better now and stop worrying about surgery.
Dr. Christopher Segler is a San Francisco Podiatrist specializing in treating heel pain. He thinks that the best treatment for heel pain depends upon the patient, not the particular procedure. It is his goal to heal heel pain and hopes that by doing so, his patients will think he is the best podaitrist in San Francisco. He travels around the San Francisco Bay Area and sees patients in the homes, offices, and even hotel rooms to treat plantar fasciitis and other causes of heel pain. If you want relief from your morning heel pain, you can reach him at (415) 308-0833.