When walking your heels repeatedly hit the ground with considerable force. They have to be able to absorb the impact and provide a firm support for the weight of the body. When pain develops in the heel it can be very disabling, making every step a problem and affecting your posture.
The sole of the heel (plantar surface): generally described as heel spur syndrome or plantar fasciitis.
Back of the heel (bursitis): inflammation of a bursa (fluid filled cavity) at the back of the heel. It is normal to have bursa separating tissues that may suffer friction, such as between the Achilles tendon and the heel bone. However, if inflamed it ca be painful.
Heel Bumps: occur at the back of the heel as firm swellings which become prominent and may rub against shoes.
Diagram of heel cross section from side showing positions of heel pain
Heel Spurs: thought to be due to strain on the structures underneath the foot.
Heel Bursitis: caused by rubbing on the back of the heel against footwear. May be caused by infection.
Heel Bumps: associated with pressure.
Heel Spurs: The pain is usually worst on standing, particularly first thing in the morning when getting up from bed. It is relatively common though usually occuring in patients over forty, the incidence increasing with age. There are no visible features on the heel but a deep localised painful spot can be found in or around the middle of the sole of the heel (see diagram). It is believed that tearing at the attachment of the ligament causes inflammation leading to pain. Although it is often associated with a spur of bone (heel spur syndrome), approximately ten per cent of the population have heel spurs without any pain.
Heel Bursitis: pain is usually felt when the ankle joint is moved and there may be a swelling on both sides of the Achilles tendon.
Heel Bumps: recognised as firm bumps on the back of the heel, they are often rubbed by shoes causing pain.
Heel Spurs: Cushioning for the heel is of little value. Your State Registered Chiropodist may initially apply padding and strapping to alter the stretch of the ligament. This is often successful at reducing the tenderness in the short term.
Your State Registered Chiropodist may suggest a course of deep heat therapy to stimulate the healing processes allowing damage to respond and heal faster.
In the long term your State Registered Chiropodist may prescribe special insoles (orthoses) to help the feet to function more effectively, thereby reducing strain on the ligaments and making recurrence less likely.
If pain from heel spurs continues, you may be referred to a GP for and oral non-steroid anti-inflammatory. Alternatively, a podiatrist may give a localised hydrocortisone injection treatment. If pain does persist, surgery may be considered.
Heel Bursitis: In most cases attention to the cause of rubbing, and appropriate padding and strapping by your State Registered Chiropodist will allow the inflammation to settle. If infection is present, your State Registered Chiropodist will refer you to your GP for antibiotics.
Heel Bumps: Adjustments to footwear is often enough to make them comfortable. A leather heel counter and wearing boots may help. However, if pain persists surgery may be necessary.
The Society of Chiropodists and Podiatrists
53 Welbeck Street
[This is a copy of a leaflet available for free. It is available in
the foyer of Paul
Trickey's clinic, and from the address above.]