Heel Pain Questions

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When your patients come in to see you and the diagnosis end up being heel pain, what are the most frequent symptoms that they’re describing to you and they’re telling you about when they come in to see you? What does heel pain feel like?

Usually when they come in they’ll explain that I’ve got severe pain in the heel. It’s usually worse first step in the morning when I get out of bed like in the morning. They’ll say if they walk for a duration, it gets a little bit better. But if they sit down and get back up, that the pain will come back and it’s one of those intermittent come and go type pain. A lot of them will say it feels like a toothache in the heel area or even into the arch area. A lot of times it will get better with rest and then it will just come right back. So it’s one of those nuisance type things that just never goes away. That’s usually I would say a typical presentation for heel pain, and we do see a lot of here at my office.

 

What causes heel pain?

The main cause of heel pain is usually a biomechanical problem in the foot and it’s in a nutshell having a foot out of alignment. There are numerous conditions. One of the most prevalent is called talotarsal dislocation syndrome. What that is in lay terms is you’ve just got a malalignment of your ankle on your heel and as you bear weight you’re getting a collapse of the ankle on the heel causing the foot to be out of alignment.

So all the bones, the joints, ligaments and a major ligament on the bottom of the foot, which we call plantar fascia, is getting pulled and constantly getting tugged and pulled onto the heel area where the insertion point is usually right there; usually the most prevalent on the medial or the inside of the heel.

As the patient bears weight, they get the collapse of the foot and that ligament pulls. And if you think of a rubber band constantly getting pulled on that area of the insertion on the heel, you eventually start getting some micro tears in that ligament and causing inflammation and pain specifically right there in that area.

The biomechanics is really a big culprit in what causes that. That is a very, very common symptom that I see. But, again, that is caused from instability or malalignment of the foot.

 

How common is heel pain? Do many people suffer from heel pain?

So many people suffer from heel pain. I would say it’s definitely the top problem that I see here in my office. I would have to say I know statistics they say usually one out of four people will suffer. I would have to say even high than that. I would go two out of four or something. It’s very common. And, again, it’s one of those problems that people just don’t get looked at because it goes away, but then it will come back. So it’s one of those issues that we see a lot of.

 

Who gets heel pain? Is it children, older people, athletes?

Well, actually I would say all of them. You get children all the way up into the elderly population will get it. Usually, in children it’s more it’s something that we call Sever’s Disease. And what that is that on the back of their heel they’ll have a growth plate that gets inflamed and, again, you’ve got a tendon called the Achilles tendon that inserts down there into the back of the heel. And, again, you can get a pulling action, but it’s actually the growth plate that gets inflamed and causes pain, not on the bottom of the heel, but more in the back of the heel.

And then as far as with more plantar fasciitis heel spurs, again, I see that in women, males, females, athletes. It’s very, very common in runners, dancers, very, very common. So I guess it’s a wide scope of patients, again, with heel pain that I see.

 

How do you treat heel pain? When someone comes in what are the ways that you’re able to treat it? What are some of the methods that you use? How do you treat heel pain?

Well, again, with any patient that comes in you want to do a full examination on them. We even do a gait analysis to see the way they’re walking and the biomechanics, which is a big part of this problem. We also have a fluoroscopy unit that we utilize. What that is it’s imaging of the foot, but it shows the foot in a dynamic way, which means we can see the foot. As you put weight down, we can see it live as far as the way the bones shift and any pathology in the foot and show the movement in there.

However, with our normal x-rays those are usually more of a static image, which is sort of like a picture view of it. So the nice things with our fluoroscopy or mini C-ARM unit that we have, we could have them put a full weight bearing and sort of see how the malalignment in the foot shows. And it’s nice the patient can see it up on our computer screen so they can see it with their own eyes and it makes a lot of sense of how a lot of these issues are occurring.

So the imaging is important, the examination. And a lot of times with these I only do one injection. I’m not one that always likes to inject and mask a problem that the patient’s having. But we a lot of times do that to get them some relief. But the ultimate main reason and main culprit for these patients suffering with heel pain is a condition we call talotarsal dislocation syndrome or what it is, is you’re getting a malalignment of your heel on your ankle. And as you bear weight, your ankle bone’s collapsing and actually we call like a partial dislocating on the heel causing malalignment or just out of displacement of the bones, ligaments and joints out of their normal position.

So it throws off not only the bones and ligaments of the foot, but the area where the plantar fascia inserts on the heel that is getting disrupted and constantly pulled as well.

And so, the ultimate solution is to correct what really causes the heel pain and that’s really what you’ve got to get to is sort of to the underlying cause of it. And good custom orthotics: we do digital custom orthotics here in our office, which are a hundred percent accurate. The devices, they’re called custom orthotics that goes into your shoes. And what they do is they put that foot, both right and left foot, in a proper neutral position, which your feet should normally be in.

And the nice thing with the company that we use, they’re based out of San Diego called Pedalign. They utilize NASA and MIT technology to produce three dimensional imaging of the feet, which from those digital imaging they’re able to produce a hundred percent accurate custom digital orthotics. And they also produce a lifetime warranty on them, which is nice. They’re one of the companies that do that and I’ve been having excellent success with that. And dealing with your regular patient, but a lot of college and professional athletes these are what they use, these digital custom orthotics. They usually do very well without having to need any type of surgical intervention or any surgery.

 

What should one expect from heel surgery for pain?

The nice thing is nowadays the way advancement and technology, if a patient does need to have surgery for the heel, it is very minimal incision that’s done. And the nice thing is the recovery period patients are usually able to bear weight right after the surgery and able to get back into the normal swing of things usually within a few weeks. So recovery is a lot different than it used to be and a lot of it is because of doing minimal incision and decreasing trauma to soft tissues, as well as even the bone. So if surgery is needed, then again recovery is pretty quick for these patients.

 

How could those folks who don’t currently have heel pain is there any way to do our level best to try to avoid it. Is there anything we can do to avoid it?

The things that I would do to avoid it is to wear real good, supportive shoes. Usually, New Balance is a good shoe to wear, just for everyday shoe gear. Shoes are important and also I recommend any athletes to make sure to do stretching before and even after any of their activities. Then if a patient is starting to get a little discomfort or pain in the feet or the heel, pain is not normal. And so, if you are having pain, you’ve got to be proactive and just make sure that you go. And I would just go straight to a foot and ankle specialist in your area, a podiatrist, and have them at least evaluate you to at least give you a piece of mind. But a lot of times if you are starting to get pain, you just don’t want to let it go because then that’s where you start running into other issues. So, again, being also proactive is important as well.

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Dr. Anthony Weinert

Anthony Weinert, DPM, FACFAS, FACCWS is a double board certified foot and ankle specialist with office locations in both Warren and Troy, Michigan. Dr. Weinert is a physician and surgeon of the foot and ankle who believes in providing his patients with the most state of the art treatments in a patient friendly environment. He believes in providing quality patient care and safety and was honored with being one of the first foot and ankle specialty centers in Michigan to receive accreditation by the Joint Commission (JCAHO) which is the gold standard in healthcare for providing patient care and safety.  He believes in the philosophy of patient education for their foot and ankle disorders and also believes to treat every patient the way he would like to be treated.

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