Heel Pain, Myths and The Facts
Have you ever had heel pain? It can be nasty and make walking or running very painful. Patients often say they have pain that is worse when they first get up in the morning and the first step is a killer! Likewise they may say if they sit for a while when they first get up, bam! -Big time pain in the heel. There are really two main causes for this problem and they are very different.
The first is plantar fasciitis and the other is heel pain syndrome otherwise known as heel fat atrophy or “bruised feet.” Each is very different and needs to be treated differently.
One myth is that these problems are caused by a ‘heel spur’. They get an x-ray and the cause is pronounced as a heel spur which is seen on the films. Must be right? Right? Not so fast. Studies have shown that when you x-ray the other foot that has no pain we see the same ‘heel spur’. It is basically a myth that a ‘heel spur’ causes heel pain, yet many patients come to my office with x-rays and a diagnosis of “heel spur pain”. Why? Well, all I can say is unless the person who is reading the x-ray or your doctor has training in treatment of the foot and ankle; expect the myth to continue. I used to think the same thing. It really comes down to training, I believe.
So if the ‘heel spur’ is a myth, what causes heel pain and how can you know the cause? As I said earlier, there are two main causes.
1.) Heel Fat Pad Atrophy
2.) Plantar Fasciitis
To see which is which, try this experiment.
1.) Pull the toes back toward your face and then push on the arch just in front of the heel. If it hurts then it’s most likely plantar fasciitis.
2.) If it does not, release the toes then simply push firmly, directly on the heel. If it is painful or tender you probably have Fat Pad Atrophy also known as ‘bruised heel’.
What causes these problems?
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Well there are many causes for each. Fat Pad Atrophy occurs usually as we age. It can happen to anyone, not just runners. It is basically a sore and tender heel. The pad that protects the heel bone begins to break down and loses its shock absorption. The fat pad thins and spreads out and gets squished!
Fat Pad Atrophy may not heal this time and it’s best to come see me sooner than later to prevent more damage. I will prescribe a heel cup. People often try gel pads but from my experience they are useless.
You may also benefit from modalities that increase circulation to the area as this is a degenerative issue process, not inflammation.
As for plantar fasciitis it is an inflammation then degeneration of the connective tissue that runs long ways from the ball of the foot to the heel. The bones of the foot form the top ‘arch’ and the connective tissue supports the arch across the bottom of the foot is the plantar fascia. It can lean and begin to break down and degenerate. We recommend modalities that increase circulation; healthy and proper foot wear and orthotics
Again, gel inserts are usually not helpful.
I am not a fan of cortisone shots for either of these but especially in the heel for fat pad atrophy as they only accelerate the degeneration of the fat pad and worsen the condition.
If you have heel pain let us sort it out for you. You can come to our free clinic every Monday from 4-6pm for a free consultation. Or ask your doctor, nurse practitioner or physician assistant for a referral to Tri State Hand Foot and Ankle Therapy. Call 301-759-4263 for more information or an appointment. Check out our radio show Saturdays at 9:30 AM on WCBC, “The People’s Health Show.”
Try therapy first at Tri State and separate fact from myth when it comes to heel pain. We treat the problem biomechanically, not just the symptoms!
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