Heel pain can occur for a variety of reasons, such as insertional Achilles tendonitis, Baxter's neuritis, or plantar fasciitis.
INSERTIONAL ACHILLES TENDONITIS
The Achilles tendon is a band of tissue that connects the calf muscle to the heel bone. Inflammation of this tendon where it attaches to the heel is referred to as insertional Achilles tendonitis. Runners with tight calf muscles are often prone to inflammation of the Achilles tendon. This condition is commonly confused with Haglund deformity, which is a different type of bony enlargement at the back of the heel. Symptoms of this problem can be:
Pain along the back of the heel
Swelling or a boney bump due to a spur formation
Pain is worse after rest or after exercise
Shoes with a firm or unpadded heel counter cause more pain
Treatment of insertional Achilles tendonitis varies based on severity as well as when the injury occurred. Conservative treatments are available, and they include being fitted for a pair of custom inserts, icing the heel, calf stretches, wearing a walking boot as recommended by your doctor, shoe modifications, and physical therapy.
If all conservative treatments fail to provide relief, then your doctor may discuss surgery. Depending on your injury, the doctor may need to perform a gastrocnemius recession or a debridement and repair. In a gastrocnemius recession, the doctor will surgically lengthen the calf muscle, which reduces stress on the Achilles tendon. A debridement and repair consists of the doctor removing part of the Achilles tendon that is damaged and repairing what remains of the healthy tendon.
When a nerve called the lateral plantar nerve becomes entrapped as it passes underneath the heel, it is referred to as Baxter's neuritis. This nerve can become entrapped due to foot structure, type of shoes worn, surfaces walked on, and activity. Symptoms of this condition include:
Pain worsens toward the end of the day
Tingling/burning/numb sensation in the bottom outside of the heel
Muscle weakness in the 5th toe occurs in a later stage
Conservative treatments are similar to that of plantar fasciitis, although with less predictable results. If those options do not relieve the heel pain, then the doctor may recommend a surgical procedure called neurolysis. With this procedure, the doctor surgically releases any areas of tissue that may impinge the nerve.
Plantar fasciitis occurs when the thick band of tissue extending across the bottom of the foot (the plantar fascia) becomes irritated and inflamed.
Frequent running and/or jumping, overly flat or high arched feet, wearing shoes that lack support, and obesity all cause stress to the plantar fascia, which can lead to plantar fasciitis. People over the age of 40 are more likely to experience this condition. A person with plantar fasciitis may experience one or more of the following symptoms:
Stabbing pain near the heel
Heel pain when you first stand up in the morning
Heightened heel pain after exercising (not during)
Most patients suffering from plantar fasciitis will find relief from conservative treatment recommended by our doctor. These treatments include being fitted for a pair of custom inserts, stretching the calf muscle, taping, icing the heel, limiting activity that stresses the plantar fasciia, and steroid injections.
In the rare occasion that all conservative options have been exhausted and the patient is still experiencing severe pain, surgery may be recommended in order to treat plantar fasciitis. In this instance, a plantar fascia release is performed. This is where a portion of the plantar fascia is severed in order to release the tension in the tissue that is causing pain.