The most common cause of heel pain is plantar fasciitis, however there are other foot injuries that also cause heel pain. Until you consider these possibilities, the problem may persist, and be resistant to the normal approaches. The stresses of running increase your chances of heel pain from other causes to occur.
Plantar Fasciitis or Heel Pain?
If you have had heel pain for a while, it could be plantar fasciitis, or it could be a more serious condition that is causing your pain. Heel pain in the initial stages is usually plantar fasciitis. If the cause of plantar fasciitis is adequately addressed, then it usually resolves fairly quickly. This is the easiest time to get rid of heel pain. But when the pain persists for weeks, months, or even years, other causes of pain should be considered. Also, a steroid injection in the heel may be part of the problem as well.
Use this blog as a guideline, but a qualified healthcare provider may be needed to help you make a diagnosis. This information is not intended to provide you with a diagnosis. It is intended to make you more informed, and knowledgeable so that you can seek resolution of your condition from the right approach.
Partial Plantar Fascial tear
This is a partial tear in the plantar fascia ligament on the bottom of the foot. This ligament helps to support the foot correctly. The inflammation of the ligament can progress to actual physical changes in the structure of the ligament itself and tearing of the fibers of the ligament.
Plantar Fasciitis and Running Posture
Have you tried to modify your running posture lately? If so, this could also be causing you to develop this problem. Partial plantar fascial rupture is usually not painful for the first 2-3 miles of the run, but then pain increases at mile 8-10, and continues. The day after a long run can be very painful. Sometimes you can trace this to a specific injury or time when this first started to occur.
This problem will require a little extra attention to clear up. A medical professional should be able to identify this problem based on their examination or perhaps further studies might be needed such as an MRI. They can put you on a rehabilitation program to eliminate the pain and this program should be followed closely. There is a very good chance of eliminating your pain if this program is followed. You will likely not do any permanent damage to the foot if this is left untreated, however, your pain probably will not get better either, or may take longer to resolve than if you had treated this sooner. If you developed a partial plantar fascial tear, it is likely you have an underlying mechanical problem. The Cluffy Lux Step insole addresses the underlying mechanical problem and should be utilized at the appropriate time, after the plantar fascial tear is healed.
Calcaneal Stress Fracture
The heel bone (calcaneus) can break if too much stress is applied to the bone too quickly. However, this injury is relatively rare. A break should be suspected if you have tried other treatments without success. Bone will generally get stronger the more you are on it and weaken, as you are more sedentary. There are specific medical conditions that will predispose you to a stress injury from weakening of the bone. An X ray is usually normal, but an MRI can diagnose this condition easily. If this is your problem, you need to get a workup for bone loss diseases to make sure you are not losing bone density from another condition. Your doctor can put you on a program to get this healed up for you. Usually, a walking boot is sufficient to get this resolved, and a fracture of the heel usually heals quickly.
When pain starts to radiate into the foot, or you have numbness on the bottom of the feet or from the ankle into the heel, then a nerve injury must be suspected. This kind of injury can result from irritation of the heel from an orthotic or a protrusion of the shoe in the heel.
Enlargement of the muscle on the inside of the arch can irritate the nerve on the inside of the heel. This can also occur along with plantar fasciitis. An enlargement of the muscle might be overlooked and should be considered when plantar fasciitis does not resolve as expected. When the more common issues resolve, the nerve injury can persist and result in chronic heel pain. If you have tried the right insole and pain persists, then a sports medicine doctor will be able to rule out a nerve injury and provide a course of treatment for resolution of this. Surgery is sometimes needed in these situations, but injections may be beneficial as well.
Infra calcaneal bursitis
A bursa is a fluid-filled sac on the bottom of the heel to reduce the stresses applied to the heel bone. It is the bodies’ way of providing a cushion. However, it can also get inflamed by continued irritation and be a cause of persistent heel pain. There will usually be a swelling noted on the bottom of the heel or there can be a nodule that you can feel through the skin on the bottom of the heel. Injections into the bottom of the heel can have side effects so carefully consider your options before trying this.
The fat pad is the bodies’ natural cushion on the bottom of the heel. With aging and obesity, the nature of the fat pad can change and is less effective at providing the needed cushion to the foot; this is always something to consider. Injection of steroids in the heel can have a similar effect and can cause a thinning of the fat pad resulting in less shock being absorbed. If you have had multiple injections, it is likely that you have fat pad thinning.
Selecting an insole, such as the Cluffy Lux Step insole, is a good idea for your shoes since it already has a gel pad built right into the heel area. Even if other problems are causing your heel pain, having a cushion under the heel is a good idea.
Plantar fascial Fibromatosis
This condition seems to have a genetic tendency and painful nodules develop on the plantar fascia ligament. The nodules are very tender with pressure applied to the foot. These are usually quite noticeable and are hard distinct nodules on the plantar fascia. When they are preventing you from exercising, they need to be addressed. Other than cutting the insole away around the nodule, they will require medical treatment. Your sports medicine doctor will be able to help you confirm this diagnosis as well as recommend treatment for this condition.
Heel pain can limit your activity and be aggravating for most people. Take good care of your feet and seek help when needed and get back to doing the things you love to do again.