FOOT PAIN - Pain On Outside Of Foot

Pain on the outside of the foot can be caused by a number of things.  The pain may be on the inner side of the foot (medial foot pain) or on the outer side (lateral foot pain). 

Thinking about whether the pain came on gradually over time or developed suddenly after an injury as well as the specific symptoms can help you work out what is causing your foot problem.

Here, we will look at the most common causes of pain on the outside of the foot.  We will look at the common causes of each condition, how they present and the classic signs and symptoms of each.  There is also a simple guide to diagnosing your side of foot pain.  You can then find out more about the best treatment options for each.

Common Causes

1)  Stress Fractures

Stress fractures are a common cause of pain on outside of the foot.  They occur when there is a small break in one of the foot bones usually from repetitive sporting activities.

The location of pain will depend on which foot bone is affected – fractures of the calcaneus or navicular bones cause lateral foot pain, stress fractures of the metatarsals can cause pain on either side of the foot depending on which metatarsal is affected.

Side of foot pain from stress fractures usually starts off quite mild and gradually gets worse.  Find out more about this common cause of pain on the side of the foot including common causes, symptoms, diagnosis and treatment in the Stress Fractures section.

2)  Ankle Sprain

Ankle sprains are the most common cause of pain on the outside of the foot following an injury accounting for 85% of ankle injuries.

Ankle sprains can affect any of the ligaments in the foot but most commonly affect the Anterior Talofibular Ligament (ATFL).  This ligament is damaged when we roll the foot inwards as the ankle rolls outwards, known as an inversion injury.  This leads to some or all of the ligament fibres being torn causing side of foot pain, swelling, bruising and instability.

35% of people who suffer from an ankle sprain go on to have recurrent problems with pain and instability often causing future sprains.  This can be avoided by thorough rehab following the initial injury.  Find out more about the common causes, symptoms, diagnosis and treatment options for pain on outside of foot in the ankle sprain section.

3)  Cuboid Syndrome

Cuboid Syndrome is a less common cause of lateral foot pain (i.e. outer side of foot pain) but it frequently does undiagnosed which can lead to symptoms being present for long periods. 

It is caused by one of the small foot bones, the cuboid, being partially dislocated out of position following an injury like an ankle sprain or from repetitive strain on the foot.

The most common symptom is pain on outside of the foot which can spread down to the toes.  Pain is worse in the morning, when walking or running especially on uneven ground and with jumping or hopping.  Symptoms ease with rest.  The area is often tender to touch with some redness and swelling.  When accurately diagnosed and treated, symptoms usually settle in a few weeks.

Anyone with ongoing lateral foot pain for more than 3 months following an ankle sprain should be assessed for cuboid syndrome as the condition affects almost 7% of ankle sprain sufferers.  Find out more about this frequently missed cause of outer side of foot pain in the Cuboid Syndrome section.

4)  Peroneal Tendonitis

Peroneal Tendonitis is another common cause of pain on outside of foot and around the heel.  It develops when there is repetitive tension through the peroneal tendons of the foot causing irritation, inflammation and degeneration.

It is usually caused by frequent overuse such as long distance running, abnormal foot position, muscle imbalance or after an ankle sprain.

Side of foot pain from tendonitis comes on slowly, gradually increasing over a few weeks or months and tends to be worse first thing in the morning and with activity, easing with rest.  Find out more about pain on the side of the foot from tendonitis in the Peroneal Tendonitis section.

5)  Tarsal Coalition

Tarsal Coalition is one of the more rare causes of side of foot pain affecting approximately 1 in every 100 people.

It is caused by two of more of the foot bones being connected to each other by an excess bar of bone.  It is a congenital problem and symptoms usually appear in the second decade of life. 

Symptoms often come on very suddenly resulting in pain, fatigue and foot cramps and the condition may cause you to walk abnormally. It can cause other foot problems such as ankle sprains and abnormal foot biomechanics.  Treatment usually consists of surgery, shoe inserts or casting to immobilise the foot.

6)  Bunions

Bunions are a common cause of deformity and pain on the outside of the foot by the big toe.

They develop when the big toe rotates inwards so it points towards the other toes.  This causes the bone at the base of the big toe to stick out at the side.  The result is side of foot pain, inflammation, redness and swelling around the big toe.  The medical term for a bunion is hallux valgus. Occasionally bunions can develop around the little toe, known as bunionettes.

There is thought to be a genetic link with bunion sufferers, especially in those whose joints are overly flexible, but they can also develop from poor footwear where the toes are squashed inwards.  Conditions such as gout and rheumatoid arthritis also increase the risk of bunions.  Mild cases respond well to the use of toe stretchers which help to realign the toes, but in more severe cases, surgery may be required.  Find out more about the common causes, symptoms and treatment options in the Foot Bunion section.

7)  Corns & Calluses

Corns and calluses can develop anywhere on the foot, but frequently appear and cause top and side of foot pain.  They develop when an area of skin is placed under repetitive friction and the skin attempts to protect itself by laying down extra layers of skin.

Calluses tend to be painless but corns tend to affect deeper into the skin which can be really painful.  There are usually simple to treat and prevent.  Find out more about the differences between the two conditions and how to treat them effectively in the Corns & Calluses section.

8)  Posterior Tibial Tendonitis

Tendonitis of the Posterior Tibial Tendon causes inner side of foot pain.

The tendon comes down the inner side of the ankle attaching under the foot and its primary function is to support the inner foot arch.  As with all types of tendonitis, it develops when there is irritation, inflammation or degeneration of the tendon, usually from repetitive overuse or injury. 

The pain gets worse with activity and eases with rest and sufferers often have flat feet.  You can find out more in the Foot Tendonitis section.

9)  Arthritis

Arthritis can cause pain anywhere in the foot but often results in side of foot pain.  There are two common types of arthritis – rheumatoid arthritis aka inflammatory arthritis and osteoarthritis aka degenerative arthritis.  Foot pain from rheumatoid arthritis is the more common of the two.  Symptoms often come and go, varying in severity.

Diagnosing Your Pain

So, as you can see, there are a number of different causes of side of foot pain.  If the pain developed due to an injury, it is most likely to be a ligament sprain or cuboid syndrome, if the pain on outside of foot came on gradually, it may be from a stress fracture or tendonitis.  Outer foot pain in adolescents may be due to Tarsal Coalition, whereas in the over 50’s it may be from bunions or arthritis.  If the skin is affected feeling dry and thickened, it is probably a corn or callus.

All new cases of pain on the outside of the foot should be assessed by your doctor to ensure accurate diagnosis and effective treatment.

If none of these are sounding like your foot pain, visit the diagnosis section for more help working out what is causing your problem and how to solve it.

Source: http://www.foot-pain-explored.com/pain-on-outside-of-foot.html#sthash.XMVD6CtO.dpuf

NIGHTTIME LEG CRAMPS - Foot Cramps at Night While Sleeping Causes and Treatment

BY ADMIN ON JANUARY 19, 2011 

Night time leg cramps are sudden involuntary contractions of the leg muscles. They are painful muscles cramps. They are extremely discomforting as they interfere your sleep.

Leg cramps at night is often seen in elderly patients, though it can occur in young adults as well.
The usual site of pain is in calf muscles.

Nighttime Leg Cramps Symptoms
The symptoms of leg cramps at night time are:

• Sudden and severe pain in calf muscles or in hamstrings at night.
• Soreness and tenderness
• Movement becomes difficult during leg cramps.
• Stony hard feeling of the leg muscles for that period.

Causes of Foot Cramps at Night
Cause of night time leg cramps: the exact cause of leg cramps during night is not known, but some of the triggering factors causing it are,

• Rigorous exercise
• Peripheral artery disease in elderly persons.
• Certain medicines such as diuretics.
• Dehydration
• Vitamin E deficiency.
• Diabetes
• Pregnancy
• Parkinson’s disease.
• Obesity.
• Excessive consumption of alcohol and smoking
• Sedentary lifestyle.

Treatment Nighttime Leg Cramps

Treatment will depend on treating the triggering factors:

• Eat vitamin and mineral rich foods and fruits: bananas, dates, almond, oranges, tomatoes, broccoli, potato, lamb, fish and pork.
• Control diabetes.
• Drink enough fluids and electrolytes.
• Wear proper fitting shoes and slippers.
• Avoid alcohol and smoking.
• Massage lightly with a soothing balm on the cramped muscles.

Source: http://www.simple-remedies.com/

WOMEN - Tips to Avoid Foot Pain From High Heels

Experts discuss foot care techniques to cope with the painful consequences of wearing high heels.

By Colette Bouchez
WebMD Feature

Reviewed by Louise Chang, MD

Do the most important men in your life -- and the shoe boxes in your closet -- bear the names Manolo, Jimmy C, Enzo, and Stevie M?  If so, then there's a good chance high heels are a part of your life.

But unlike Carrie Bradshaw in TV's Sex and the City -- who chased men, taxis, and sometimes a dog in the park while teetering on 4-inch stilettos -- high-heeled life in the real world can be a killer.

"Women do love their high heels, but if you wear them all the time, significant foot pain and other problems can ensue, either as a direct result of the heels or exacerbated by them," says Morris Morin, DPM, director of podiatric medicine at the Hackensack University Medical Center.

Problems range from common concerns like bunions, corns, and calluses to more complex issues like misshapen hammertoes or that excruciating pain in the ball of the foot that seems to grow worse with each passing year. 

Still, many women refuse to give up their high heels: A survey conducted by the American Podiatric Medical Association showed some 42% of women admitted they'd wear a shoe they liked even if it gave them discomfort; 73% admitted already having a shoe-related foot issue.

So what's the answer? Doctors say if you must wear them at all, take a few precautions, and catch and treat problems early on. If you do, you'll not only avoid many high-heel problems, but you'll make the time you spend in spikes a happier day for your feet.

(Do you often wear high heels? Share your experiences on WebMD'sWomen’s Health: Friends Talking message board.)

High Heels and Foot Pain: What You Should Know

Anytime you wear shoes that are tight or constrict the natural shape of your foot, doctors say it's bound to cause foot pain.

But when you add high heels in to the equation, podiatrist Stuart Mogul, DPM, says pain can quickly escalate to damage.

"In addition to restricting the foot, you are also increasing the weight on the area that is restricted, so you're not only crushing your toes, but you're crushing them and then putting weight on them, and that's a problem," says Mogul.

Among the most common problems he sees are painful, aching bunions -- those bony protrusions that usually pop up at the base of the big toe and distort the shape of the foot.

"High heels don't cause bunions, but they sure can aggravate them. Both the heel height and the point of the shoe can play a role," says Mogul.

Moreover, he says some women who have bunions also have a displaced bone on the bottom of the big toe joint, which changes the way the foot "tracks" or acts during motion.

"If the foot is then placed in a high heel, and pitched forward, the pressure on these bones increases and bunion pain grows worse," he says. 

While integrating lower heels into your wardrobe can help some, often the best solution is bunion surgery to straighten the bone.

If you're wearing high heels on a daily basis, it's likely you've already experienced two more common problems: corns and calluses. These thickened layers of dead skin usually occur on the toes or sides of the foot and are actually the body's way of defending your feet against assault. Only in this case, says Morin, your shoes are the enemy.

"When you start developing corns and callus, or even ingrown toe nails, pressure from shoes that don't quite fit is often the problem," says Morin.

Other times it can be the result of a "hammertoe" -- a condition that causes the bone of the affected toe to curl under, leaving the top to rub against the shoe. When that shoe is a high heel, says Morin, problems and pain are intensified. 

While wearing a lower heel shoe can help some, the solution may require a surgical procedure that helps straighten the hammertoe.

High Heels and Midlife Crisis

It's true that nothing can lift the spirits like a sassy new pair of high heels.   But if it seems those heels were a lot more comfortable in your 20s and 30s then they are in your 40s, 50s, and beyond, you're right.

Feet change with age, say experts, and some of those changes can make wearing high heels a lot less comfortable.  One of the most common: a loss of fat in the bottom of the foot.

"As you age, you lose some of the fatty deposits that normally protect the ball of the foot -- and some of it also slides forward towards the toes," says Morin.

When we slip our feet into those strappy stiletto sandals and step down, he says our weight is thrown on the spot where we have less protection.

"In extreme cases you actually have the bony ends of the foot grating down into the sole of the shoe with almost no protection at all," he says.

Not only does this cause pain, but it may also increase your risk of stress fractures and osteoarthritis in the feet.

And while some doctors attempt to repad the foot using injections of silicone or wrinkle filling injections like Restalyne, both Morin and Mogul say it's not a good idea.

"These injectables are not meant to withstand the pressure of body weight; they don't last and they tend to move around from the weight," says Morin.

Moreover, the American Orthopedic Foot and Ankle Society warns women against these and other strictly cosmetic procedures for the feet. Calling the trend alarming, they warn consumers that risks -- including infection, nerve injury, and difficulty walking -- frequently outweigh benefits.

A much better idea for bottom-of-the-foot pain, says Morin, is the use of heavily padded insoles. "They act as a buffer between your foot and the ground, and that's all you really need."

And finally, if you've worn primarily high heels for most of your life, you may experience shrinkage of the Achilles tendon, the area that runs from the back of the heel to the calf. This can result in pain when wearing a low-heel shoe or even the inability to walk barefoot.

The antidote here: Stretching exercises like runners do. In rare instances, Mogul says you may need surgery to lengthen the Achilles tendon.

5 Tips to Protect Your Feet When Wearing High Heels

We know you love your high heels, so we won't even hint at the fact that you'd be better off in sneakers.  At the same time, what good is that great pair of red patent-leather stilettos if all you can do is sit and admire them?

If you’re going to wear heels, WebMD combined advice from our two experts, along with suggestions from the American Podiatric Association, to protect your feet.

1.       Get the best-fitting high heel possible.  While this may seem like a given, stop and think: How many pairs of high heels cause your feet toslide to the front, leaving a gap big enough for a small cell phone behind your heel?  Mogul says high heels that don't fit properly cause the front of the foot to fly forward, creating more pressure -- and pain -- on toes. Look for narrow heels with a snug but not tight fit to correct the problem.

2.       Cushion, cushion, cushion. While a full-shoe insert can help, if you have pain in the ball of the foot -- or you'll be standing in your heels a long time -- invest in silicone metatarsal pads. They look like flattened gummy bears, but they do a super job of shock absorption, says Morin.  "It's like replacing the fat padding you lost."

3.       Wear a thicker heel for stability. "A thicker heel will give you better balance and may help relieve some pressure by distributing the weight on your foot more evenly, says Morin.  Alternating heel heights can also help reduce problems with the Achilles tendon.

4.       Pay attention to the "slope" or "pitch" of the heel.  While some 4-inch heels will give you a straight drop down to the flatbed portion of the shoe, others will be a more gradual slope. This may be easier on the arch, says Morin, and might help relieve some pain in the ball of the foot.

5.       Wear open-toe high heels to relieve pressure on corns and calluses. See a podiatrist to have corns and calluses professionally removed and correct the problem that’s causing them. But if that's not possible, opt for open-toe shoes to take pressure off inflamed areas.

Source: http://www.webmd.com/

WOMEN - The Real Harm in High Heels

The Real Harm in High Heels

Your killer heels are killing much more than you think. One in 10 women wear high heels at least three days a week and a third have fallen while wearing them. Statistics show that high heels are one of the biggest factors leading to foot problems in women, with up to a third suffering permanent problems as a result of prolonged wear. Natalie A. Nevins, DO, an osteopathic physician from Hollywood, Calif. who specializes in family medicine, osteopathic manipulative medicine, and neuromusculoskeletal medicine, explains the common medical problems associated with prolonged high heel wear and provides tips to avoid them.

High Heels: The Higher the Better?

Those perfect pumps can create the perfect storm for permanent health problems. If you frequently wear high heels, you are setting yourself up for long-term issues. "Extended wear of high heels and continually bending your toes into an unnatural position can cause a range of ailments, from ingrown toenails to irreversible damage to leg tendons. Additionally, cramming your toes into a narrow toe box can cause nerve damage and bunions," says Dr. Nevins. "High heels have also been linked to overworked or injured leg muscles, osteoarthritis of the knee, plantar fasciitis and low back pain," she adds.

According to Dr. Nevins, when you wear high heels - shoes with a heel two inches or higher - your foot slides forward in your shoe, forcing the toes into the unnatural shape of the shoe and redistributing your weight incorrectly. The increased weight on your toes causes your body to tilt forward, and to compensate, you lean backwards and overarch your back, creating a posture that can strain your knees, hips, and lower back. "The change to the position of your spine puts pressure on nerves in the back and can cause sciatica, a condition where nerves become trapped, triggering pain and numbness as far down as the feet," Dr. Nevins adds.

High Heels and Chronic Pain

Over time, wearing high heels can shorten the muscles in your calves and in your back, leading to pain and muscle spasms. "Any time you wear shoes that restrict the natural shape of your foot, you’re at risk for experiencing pain," Dr. Nevins points out. According to Dr. Nevins, many women who wear high heels often suffer a shortening of the Achilles tendon because once the heel is pointed upwards, it tightens up. Stretching it again or switching to flats can be very painful; it can even lead to plantar fasciitis. "This tendon is designed to be flexible, so the foot can lie flat or point. With repetitive wear, you can develop unhealthy patterns that can persist even when you’re not wearing high heels," adds Dr. Nevins.

Do You Have to Give Up Your Heels?

No, but to avoid the problems that develop over time, Dr. Nevins recommends the following routines:

1. Choose sensible heels. Select shoes with low heels - an inch and a half or less - and a wide heel base; a slightly thicker heel will spread the load more evenly. Narrow, stiletto-type heels provide little support and three inch or higher heels may shorten the Achilles tendon. 
2. Wear soft insoles to reduce the impact on your knees.
3. Make sure your shoes are the right size so the foot doesn't slide forward, putting even more pressure on the toes. Pick a shoe with a wide enough toe box to allow you to wiggle your toes.
4. Wear heels on days that require limited walking or standing.
5. Alternate your shoe choice throughout the day or from one day to the next. Don't wear your high heels all day; and wear more comfortable shoes, such as athletic or walking shoes for commuting to and from work. Wearing shoes that allow your body to move naturally during walking will allow your feet, legs, hips and back to stretch.
6. Stretch. Take time every day to stretch your calf muscles and feet. Dr. Nevins recommends standing on the edge of a step with your shoes off. With your weight on the balls of your feet and your heels extending off the edge, drop your heels down to stretch. You can also put a pencil on the floor and try to pick it up with your toes.

The Final Word on Foot Health

Don't let your sense of style cripple your ability to stand or step pain-free. "Your feet are, quite literally, your base of support. If your feet aren’t happy, nothing above them will be," says Dr. Nevins. "Take a closer look at your shoe selection and take small steps now to prevent big foot problems later."

Source: http://www.osteopathic.org/

High heel horrors! The hidden cost to your body of those crucial extra inches

By PAT HAGAN
UPDATED: 14:56 GMT, 9 September 2008

More women are wearing higher heels, and for longer, and experts are increasingly concerned about the long-term damage they are doing to their feet.

Recent research suggests that up to a third of women suffer permanent problems as a result of their prolonged wearing of 'killer heels', ranging from hammer toes and bunions to irreversible damage to leg tendons.

Many of the problems - which can occur simultaneously - are caused by the increased pressure high heels put on the ball of the foot; the higher the heel, the greater the pressure. The knee and back can also be affected.

High heels are very popular, especially with celebrities such as Gwyneth Paltrow, but there may be a steep price to pay in the long-term

High heels in the form of stilettos first became popular in the Thirties, but while heels used to be largely 'special occasion' wear, thanks to the success of shows such as Sex And The City they have become de rigueur for every day.

One in ten women wears them at least three days a week, and a recent survey found a third had hurt themselves falling while wearing high heels.

There are other consequences, as consultant podiatric surgeon Mike O'Neill, spokesman for the Society of Chiropodists and Podiatrists, explains: 'High heels make you raise your heel and as soon as you do that your centre of gravity is pushed forward.

'What happens then is you bend your lower back to compensate for this and that changes the position of your spine, putting pressure on nerves in the back.'

This can cause sciatica, a painful condition where nerves become trapped, triggering pain and numbness as far down as the feet. Another common problem, says O'Neill, is that the Achilles tendon - which runs up the back of the leg from the heel - becomes permanently damaged.

'This tendon is designed to be flexible, so the foot can lie flat or point. But many women who wear high heels too often suffer a shortening of the tendon because once the heel is pointed upwards, it tightens up. Stretching it again can be very painful.

'When you try to put your foot into flat shoes you get a lot of pain in the back of the heel. I've seen 70-year-olds still hobbling around in high heels because they can't put their feet flat any more, it's just too painful.'

Most women can avoid this by sticking to heels no higher than 1.5in, he adds. But 3in or more can shorten the Achilles tendon - and you don't have to be wearing them every day, just more than once or twice a week.

Other common complaints include bunions, bony growths at the base of the big toe caused by tight, ill-fitting shoes, and socalled 'pump bumps', where straps and the rigid backs of pump-style shoes cause a bony enlargement on the heel.

Many women also develop hammertoes, where tight-fitting shoes force them to crumple up their toes, shortening the muscles inside and leaving them permanently bent.

The risks to today's teenagers are thought to be particularly great as they begin wearing high heels at an early age, before their bodies are fully developed. They run the risk of hip trouble in adulthood and problems with back pain from the stress placed on their spines as youngsters.

To minimise the risks of high heels, choose a slightly thicker heel as this will spread the load more evenly. Wear soft insoles to reduce the impact on your knees - and make sure your shoes are a snug fit so the foot doesn't slide forward, putting even more pressure on the toes.

Finally, 'wear high heels around the house for a few hours before you go out', says O'Neill. 'That gives feet a chance to get used to them before you try something more strenuous like dancing.'

But it's not all bad news. Italian research suggests women who wear up to a 2in heel may enjoy a better sex life.

That's because holding the foot at a 15-degree angle - as with a 2in heel - increases electrical activity in the pelvic muscles that play a vital role in sexual performance and satisfaction.

Source: http://www.dailymail.co.uk

HIGH HEELS - Study: Wearing high heels causes long-term foot damage, “clawing of the toes”

WEDNESDAY, AUG 28, 2013 03:19 AM MPST

Created by British orthopedic specialists, this 3D scan of a foot will make you think twice about wearing stilettos 

EJ DICKSON


Enlarge(Credit: Screenshot, YouTube)

Bad news for clubgoers and upscale shoe fetishists: those gravity-defying Louboutins in your closet are causing irreversible damage to your ankle and foot, says a team of British orthopedic specialists.

Using revolutionary 3D scanning technology, researchers at North London’s Royal National Orthopaedic Hospital have created an image of a contorted, misshapen female foot in a high-heeled shoe. For the first time ever, the animation, which was compiled from hundreds of 2D scans of patients’ feet, allows doctors to see the effects of wearing high heels “in real time,” providing irrefutable evidence of the long-term damage caused by wearing such shoes.

In a press release for the study, consulting orthopedic surgeon Andy Goldberg says that instead of looking at isolated X-rays of a foot and ankle from one angle, the PEDCat 3D scanner lets doctors see how the foot and ankle function inside shoes “fully weight bearing.” “This will help us treat patients earlier to prevent long term problems, and influence the design of new and better footwear in the future,” says Goldberg.

In the above animation, Goldberg further explains the grisly effects of prolonged high heel-wearing on the feet, including intense pain and “fixed clawing of the toes” (which is like elf feet, but in reverse). “For many years,” Goldberg adds “our feet have had to fit into someone else’s ideas of someone else’s ideas of our shoes rather than making shoes to fit our feet, and that paradigm has to change.” Food for thought next time you’re shopping for heels that the TSA would classify as lethal weapons.

Source: http://www.salon.com/

HEEL PAIN - Thumb Massage for Heel Pain Relief

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HEEL PAIN - What is heel pain? What causes heel pain?

Last updated: 14 April 2014

Heel pain is a very common foot problem. The sufferer usually feels pain either under the heel (planter fasciitis) or just behind it (Achilles tendinitis), where the Achilles tendon connects to the heel bone.

Even though heel pain can be severe and sometimes disabling, it is rarely a health threat. Heel pain is typically mild and usually disappears on its own; however, in some cases the pain may persist and become chronic (long-term).

There are 26 bones in the human foot, of which the heel (calcaneus) is the largest. The human heel is designed to provide a rigid support for the weight of the body. When we are walking or running it absorbs the impact of the foot when it hits the ground, and springs us forward into our next stride. Experts say that the stress placed on a foot when walking may be 1.25 times our body weight, and 2.75 times when running. Consequently, the heel is vulnerable to damage, and ultimately pain.

In the majority of cases, heel pain has a mechanical cause. It may also be caused by arthritis, infection, an autoimmune problem trauma, a neurological problem, or some other systemic condition (condition that affects the whole body).

Fast facts on heel pain

Here are some key points about heel pain. More detail and supporting information is in the main article.

• Heel pain is usually felt either under the heel or just behind it.
• Heel pain has a prevalence of 3.6%.
• US studies estimate that 7% of older adults report tenderness under the heel.
• Plantar fasciitis is estimated to account for 8% of all running-related injuries.
• There are 26 bones in the human foot, of which the heel is the largest.
• Pain typically comes on gradually, with no injury to the affected area. It is often triggered by wearing a flat shoe.
• In most cases the pain is under the foot, towards the front of the heel.
• The majority of patients recover with conservative treatments within months.
• Home care such as rest, ice, proper-fitting footwear and foot supports are often enough to ease heel pain.
• To prevent heel pain, it's recommended to reduce the stress on that part of the body.

What are the signs and symptoms of heel pain?

The sufferer usually feels pain either under the heel (planter fasciitis) or just behind it (Achilles tendinitis), where the Achilles tendon connects to the heel bone.

Pain typically comes on gradually, with no injury to the affected area. It is frequently triggered by wearing a flat shoe, such as flip-flop sandals. Flat footwear may stretch the plantar fascia to such an extent that the area becomes swollen (inflamed).

In most cases, the pain is under the foot, toward the front of the heel.

Post-static dyskinesia (pain after rest) - symptoms tend to be worse just after getting out of bed in the morning, and after a period of rest during the day.

After a bit of activity symptoms often improve a bit. However, they may worsen again toward the end of the day.

What are the causes of heel pain?

Heel pain is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel.

The most common causes of heel pain are:

• Plantar fasciitis (plantar fasciosis) - inflammation of the plantar fascia. The plantar fascia is a strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot. When the plantar fasciitis is stretched too far its soft tissue fibers become inflamed, usually where it attaches to the heel bone. Sometimes the problem may occur in the middle of the foot. The patient experiences pain under the foot, especially after long periods of rest. Some patients have calf-muscle cramps if the Achilles tendon tightens too
• Heel bursitis - inflammation of the back of the heel, the bursa (a fibrous sac full of fluid). Can be caused by landing awkwardly or hard on the heels. Can also be caused by pressure from footwear. Pain is typically felt either deep inside the heel or at the back of the heel. Sometimes the Achilles tendon may swell. As the day progresses the pain usually gets worse
• Heel bumps (pump bumps) - common in teenagers. The heel bone is not yet fully mature and rubs excessively, resulting in the formation of too much bone. Often caused by having a flat foot. Among females can be caused by starting to wear high heels before the bone is fully mature
• Tarsal tunnel syndrome - a large nerve in the back of the foot becomes pinched, or entrapped (compressed). This is a type of compression neuropathy that can occur either in the ankle or foot
• Chronic inflammation of the heel pad - caused either by the heel pad becoming too thin, or heavy footsteps
• Stress fracture - this is a fracture caused by repetitive stress, commonly caused by strenuous exercise, sports or heavy manual work. Runners are particularly prone to stress fracture in the metatarsal bones of the foot. Can also be caused by osteoporosis
• Severs disease (calcaneal apophysitis) - the most common cause of heel pain in child/teenage athletes, caused by overuse and repetitive microtrauma of the growth plates of the calcaneus (heel bone). Children aged from 7-15 are most commonly affected
• Achilles tendonosis (degenerative tendinopathy) - also referred to as tendonitis, tendinosis and tendinopathy. A chronic (long-term) condition associated with the progressive degeneration of the Achilles tendon. Sometimes the Achilles tendon does not function properly because of multiple, minor microscopic tears of the tendon, which cannot heal and repair itself correctly - the Achilles tendon receives more tension than it can cope with and microscopic tears develop. Eventually, the tendon thickens, weakens and becomes painful.

Heel pain may also be caused by:

• 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 and tired.

When to call a doctor about heel pain

See your doctor as soon as possible if you experience:

• Severe pain accompanied by swelling near your heel
• There is numbness or tingling in the heel, as well as pain and fever
• There is pain in your heel as well as fever
• You are unable to walk normally
• You cannot bend your foot downwards
• You cannot stand with the backs of the feet raised (you cannot rise onto your toes).

You should arrange to see a doctor if:

• The heel pain has persisted for more than one week
• There is still heel pain when you are not standing or walking.

Diagnosing heel pain

A podiatrist (doctor who specializes in the evaluation and treatment of foot diseases) will carry out a physical examination, and ask pertinent questions about the pain. The doctor will also ask the patient how much walking and standing the patient does, what type of footwear is worn, and details of the his/her medical history. Often this is enough to make a diagnosis.

Sometimes further diagnostic tests are needed, such as blood tests and imaging scans.

What are the treatment options for heel pain?

Treatment for plantar fasciitis - the vast majority of patients recover with conservative treatments (designed to avoid radical medical therapeutic measures or operative procedures) within months.

Home care such as rest, ice-pack use, proper-fitting footwear and foot supports are often enough to ease heel pain.

• Non-steroidal anti-inflammatory drugs (NSAIDs) - medications with analgesic (pain reducing), antipyretic (fever reducing) effects. In higher doses they also have anti-inflammatory effects - they reduce inflammation (swelling). Non-steroidaldistinguishes NSAIDs from other drugs which contain steroids, which are also anti-inflammatory. NSAIDs are non-narcotic (they do not induce stupor). For patients with plantar fasciitis they may help with pain and inflammation
• Corticosteroids - a corticosteroid solution is applied over the affected area on the skin; an electric current is used to help absorption. Alternatively, the doctor may decide to inject the medication. However, multiple injections may result in a weakened plantar fascia, significantly increasing the risk of rupture and shrinkage of the fat pad covering the heel bone. Some doctors may use ultrasound to help them make sure they have injected in the right place Corticosteroids are usually recommended when NSAIDs have not helped
• Physical therapy (UK: physiotherapy) - a qualified/specialized physical therapist (UK: physiotherapist) can teach the patient exercises which stretch the plantar fascia and Achilles tendon, as well as strengthening the lower leg muscles, resulting in better stabilization of the ankle and heel. The patient may also be taught how to apply athletic taping, which gives the bottom of the foot better support
• Night splints - the splint is fitted to the calf and foot; the patient keeps it on during sleep. Overnight the plantar fascia and Achilles tendon are held in a lengthened position; this stretches them
• Orthotics - insoles and orthotics (assistive devices) can be useful to correct foot faults, as well as cushioning and cradling the arch during the healing process
• Extracorporeal shock wave therapy - sound waves are aimed at the affected area to encourage and stimulate healing. This type of therapy is only recommended for chronic (long-term) cases, which have not responded to conservative therapy
• Surgery - the plantar fascia is detached from the heel bone. This procedure is only recommended if nothing else works. There is a risk that the arch of the foot is subsequently weakened.

Treatment for heel bursitis - effective treatment depends on the doctor being able to distinguish heel bursitis as a separate condition to plantar fasciitis. The patient may have to use a cushioning insole or heel cup to limit the movements, which are causing the bursitis. This treatment, along with plenty of rest is usually effective. In severe cases, the patient may require a steroid injection.

Treatment for heel bumps - the inflammation behind the heel may be relieved with ice, compression and a change of footwear. There may also be temporary help with Achilles pads, tortoise and heel grip pads. Sometimes the doctor may administer cortisone injections for pain. In severe cases the bumps may have to be removed surgically.

Home care - in cases that are not severe, home care is probably enough to get rid of heel pain.

• Rest - avoid running or standing for long periods, or walking on hard surfaces. Avoid activities that may stress the heels
• Ice - place an ice-pack on the affected area for about 15 minutes. Do not place bare ice directly onto skin
• Footwear - proper-fitting shoes that provide good support are crucial. Athletes should be particularly fussy about the shoes they use when practicing or competing - sports shoes need to be replaced at specific intervals (ask your trainer)
• Foot supports - wedges and heel cups can help relieve symptoms.

Preventing heel pain

Prevention of heel pain involves reducing the stress on that part of the body. Tips include:

• Barefeet - when on hard ground make sure you are wearing shoes
• Bodyweight - if you are overweight there is more stress on the heels when you walk or run. Try to lose weight
• Footwear - footwear that has material which can absorb some of the stress placed on the heel may help protect it. Examples include heel pads. Make sure your shoes fit properly and do not have worn down heels or soles. If you notice a link between a particular pair of shoes and heel pain, stop wearing them
• Rest - if you are especially susceptible to heel pain, try to spend more time resting and less time on your feet. It is best to discuss this point with a specialized health care professional
• Sports - warm up properly before engaging in activities that may place lots of stress on the heels. Make sure you have proper sports shoes for your task.

Written by Christian Nordqvist

Source: http://www.medicalnewstoday.com/