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Portsmouth Foot Care
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From running to just walking to the grocery store, we all want to enjoy our daily activities to the maximum, but foot pain can pose a real problem in our lives.  The type of foot pain that occurs at the heel can occur over a wide range of age groups and affect people with different physical activity levels.  But before we explore what causes heel pain, it is important to understand the basic structure of your heel. The heel bone called the Calcaneous, is the biggest bone in your foot. This bone serves as the attachment for various muscles, tendons, and ligaments, which help with the function of your foot. The heel bone is protected by fat pad which helps to cushion the heel bone at every step with take in our busy lives! These fat pad and other structures related to the heel bone can be affected and thus pain can be elicited in this area of the foot.

Let us Explore the Causes of Heel Pain:

Whether you are a sports lover, a shoe-with-high-heels lover, a teenager that is involved in sports or an elderly patient, you might have experience heel pain that can be disabling. The causes of heel pain can vary and it is very important to identify the proper causes so that the treatment is a success.

Some of the many causes are:

Plantar fasciitis: is inflammation of the plantar fascia, which is a ligament like structure on the bottom of the foot, which gives support to your foot arches. This condition is associated with spurs, which are bony growths in you heel bone at the sites of attachments of the fascia.  This cause is often seen in athletes due to overuse/stretch of the fascia. One symptom related to plantar fasciitis is that is worse in the morning and lessens as the day progresses

Other cause is having problems with gait.Patients who tend to over pronte (pronation is the normal mechanism in which your foot flattens the medial arch in order to adapt to changes in the ground and absorb ground reactive forces when walking) are predisposed to overstretching the ligaments and tendons around the heel area thus causing pain. This type of problem is often seen in patients who have flat feet or are obese.
There can also be trauma/injury to the heel in which case the pain can be elicited when compression is applied to the heel or when you bear weight and thus the pain is worsen with activity. In this case it is imperative you see your podiatrist to determine if there is any fractures/breakage to the heel bone or other nearby bony structures.  
Other cause can be Achilles tendonitis, which is inflammation of the Achilles tendon, the largest and strongest tendon in the body. This tendon attaches to the back of heel bone and if there is irritation, damage or any type of trauma to it, it can cause heel pain which can be felt in the back of the heel instead of the bottom of it as it is seen with plantar fasciitis pain.
In addition, there can be neurological causes which are the result of the nerves that pass around the heel to be entrapped around structures in the heel and thus can lead to abnormal sense of sensation around the heel bone. In the elderly fat pad atrophy, which is the disappearance of the normal fat around the heel, can be responsible for pain in the heel. This is because the heel bone is now in direct contact with the ground with only skin protecting it from the impact forces that are absorbed by the foot as you walk.

Finally, in adolescents that are active in sports and are eliciting stress in the heel bone, there can be heel pain associated with calcaneal apophysitis (which is irritation of the growth plate of heel bone). This condition can be painful and is usually relieved with rest.


When is the Best Time to See your Podiatrist and How is Heel Pain Diagnose and Treated?

It is imperative to see your podiatrist if your symptoms persist, if there was trauma to your foot and if this pain is impeding your normal daily activities.
Your podiatrist will diagnose your heel pain based on clinical signs and symptoms. There can be use of imaging studies like x-rays in order to determine what is the cause of the heel pain.
Regarding the treatment of heel pain, it is based on the type of cause of the pain. Usually, heel strapping, steroid injections and the use of orthotics help to relieve the pain and treat gait abnormalities. If there is a fracture due to trauma, the treatment approach will be different from the conservative treatment previously mention which can include surgery and immobilization for a certain period of time. 

Preventative Measures:

It is important to wear supportive footwear in order to prevent injuries when exercising. Also, it is important to warm up and properly stretch before undertaking any physical activity. If the cause of heel pain is obesity, it is important to talk to your doctor to get into a plan to regulate your weight in order to help your heel pain.

Your Hometown Foot Care has offices in Columbus, Waverly and Portsmouth, Ohio. Please visit www.HometownFootCare.com/offices for information about our locations; including maps, door to door directions and contact information.

By Dr. D. Charles Greiner
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