If distinguishing between all of these possible injuries to the heel isn’t perplexing enough, consider Baxter’s Nerve Entrapment. This tricky injury affects the outside part of the posterior tibial nerve as the nerve snakes around the bottom of the foot. When this nerve is compressed or pinched, the heel will be in pain and the bottom of the foot will be numb. Feet with Baxter’s Nerve Entrapment will become increasingly painful throughout the day, and can be aggravated by pronation.

Part of the reason why Baxter’s Nerve Entrapment is so difficult to diagnose is because of the complexity of the foot’s structure; Baxter’s Nerve Entrapment occurs in an intersection for multiple nerves, not to mention other surrounding tissues. It also occurs in a specific part of the posterior tibial nerve, after this nerve divides into two branches on the inside of the ankle. On top of that, this part of the foot is close to the bottom of the calcaneus where heel spurs may form, providing further opportunity to aggravate the nerve.

There are limited treatments for Baxter’s nerve entrapments. Over the counter or custom orthotics can be helpful in controlling pronation, flatfeet and other biomechanical issues. If surgery is a viable option, a procedure to surgically release the nerve, called external neurolysis, will often be conducted. Neurolysis identifies the physical irritation of the nerve, releases the strictures and allows the nerve to return to normal function. Dr. Murray and Dr. Chang have found success through conducting cryosurgical neurolysis, which is an out patient method using cold to ablate the Baxter’s nerve. Be sure to discuss the pros and cons of your this procedure with your podiatrist.

Haglund’s Deformity is a bony enlargement in the back of the heel. When this enlargement rubs against the Achilles tendon’s surrounding tissues, it can lead to painful bursitis. This is especially painful when wearing a shoe that is tight or rigid along the heel.

Heredity can cause Haglund’s Deformity in one or both feet. High-arched feet, a tight Achilles tendon and supination (the outward rotation of the foot and ankle while walking) can all aggravate the swollen bursae. Your podiatrist will be able to detect this because your heel will have a noticeable bump, and will be swollen and red near the inflamed tissue. Your podiatrist may also take an X-ray while conducting a diagnosis to understand the structure of the heel bone, and thereby find the best treatment options for you.

The first step to treating Haglund’s Deformity should be diagnosing the root cause behind its development. Until you identify the root cause it will be difficult to prevent the pain from Haglund’s Deformity in the long term.

The immediate treatment for Haglund’s deformity include the good-old home remedies of rest (but not completely, just enough to take the stress off of the affected area), ice two times per day for twenty minutes at a time, and ask your podiatrist about methods for compression to reduce the swelling. Your podiatrist will recommend that you take non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the swelling and to relieve pain. In extreme cases, cortisone injections may help relieve pain. However, be wary of using these injections long-term, as they are not curative, the only relieve pain and inflammation.

Additionally, your doctor will recommend appropriate footwear and inserts for your shoes: these include heel grip pads, heel lifts and heel pads. Backless or soft backed shoes can help minimize the irritation, and over the counter and custom orthotics can help support the arches of the foot to control the foot’s motion.

Finally, consult your podiatrist for exercises and stretches that will increase muscle strength and relieve tension from the Achilles tendon. Physical therapy can be a productive option, in which exercises can help prevent the pain long-term and ultrasound methods can reduce immediate inflammation.

In extreme cases, complete immobilization or surgery may be necessary. Surgery for Haglund’s deformity reduces the prominence on the back of the heel so that the pressure from the shoe does not occur. In this procedure, Achilles is retracted to reveal the calcaneus, and then some bone is removed, the calcaneus is shaped and rounded so that pressure does not occur. Another method is to take out a wedge of bone from the calcaneus, shortening it, a method called “wedge osteotomy”.

In order to prevent Haglund’s deformity, avoid wearing shoes with rigid heel backs. Use arch supports or orthotics to control the motion of your foot, avoid running excessively on hard surfaces or excessively uphill with pounding strides, and engage in strengthening and stretching exercises for the Achilles tendon and surrounding muscles in order to prevent the Achilles from tightening up and aggravating Haglund’s deformity symptoms.

The foot only contains one naturally occurring bursal sac between the Achilles tendon and the heel bone, which protects the Achilles from the pressure against the heel bone during ambulation. However, shoes may put pressure on this bursa. The bursa might also incur trauma from walking on hard ground. And, though they are not naturally occurring, bursa sacs can also form, and become inflamed, in other parts of the foot, including the bottom of the heel, and the metatarsal plate, the outside of the foot below the fifth toe, and so on.

There are a variety of treatments for bursitis of the heel. Bursitis on the bottom of your heel (which is called infracalcaneal bursitis) is common in heels with thinning fat pads. Gel heel cushions or custom made orthotics (that have a horse-shoe cut and extra foam in the heel) can be lifesavers in reducing the pain. For bursitis of the posterior heel (retrocalcaneal bursitis), try to avoid going barefoot and to reduce the stress on the Achilles tendon by not over flexing your heel – the tighter your Achilles becomes, the more you compress the bursa sacs of the posterior heel. Heel lifts can help this, or wearing shoes with elevated heels (note that this method is not sanctioning high heels, as high heels can provide little comfort or support and usually are tight in the areas where your bursitis is most inflamed). Products such as AirHeel made by Aircast can help massage the bottom and back of the heel, helping to decrease pain.

In addition to being aware of foot-wear and inserts, be sure to modify your activity level to reduce the pain initially. Taking non-steroidal anti-inflammatory drugs (NSAIDs) and icing twice a day for 20 minute periods can help reduce the swell that leads to heel pain. Cortisone injections (more powerful anti-inflammatory medications) can be considered if your symptoms are persistent. After the swelling and pain has receded, ask your podiatrist about working with a physical therapist to strengthen the affected area in order to avoid bursitis by using your muscles in a more safe and efficient manner.

If all these treatment methods fail, surgery may be the best option to excise a painful bursa (note that this is in rare cases). Consult Dr. Murray and Dr. Chang for the best treatment method for your individual needs.

Injuries to the Achilles tendon, the tissue that connects the calf muscle to the heel bone, can cause considerable heel pain. The most common Achilles injuries are Achilles tendonitis and tendonosis, the former being inflammation of the Achilles tendon and the latter being degeneration of Achilles tendonitis. The inflammation from Achilles Tendonitis is usually short-lived. Over time, if tendonitis is not treated, it can degenerate into a worse condition called tendonosis, marked by tears in the tendon. In rare cases, chronic degeneration with or without pain may result in rupture of the tendon.

The most common risks to the Achilles, similar to the prognosis for stress fractures, are sudden increases of repetitive activity without giving the Achilles tendon the proper time to repair itself from the micro-injuries to the tendon fibers caused by intense activity. Additionally, Achilles injuries may be due to physiological reasons such as flat feet, which put extra pressure on the tendon while walking or running.

Achilles tendonitis and tendonosis will result in pain, aching and tenderness along the tendon’s path, increasing when the sides of the tendon are squeezed but with less pain in the back of the tendon. To diagnose Achilles injuries, your podiatrist will examine the foot, its range of motion, and may conduct further assessment with imagining techniques such as X-rays.

Fractures can be another cause of heel pain. Your heel bone, called the calcaneus, can incur fractures like any other bone. Calcaneal fractures, however, are dangerous because of the physiology of the calcaneus and the bones with which it forms a joint. The breaking of the calcaneus’s thin, yet hard outer shell reveals a softer bone inside that shell. Once the outer shell is broken, the entire bone is prone to collapse and fragmentation. Breaking the calcaneus can have negative effects on the joint it creates with the talus and cuboid bones, bones further of the foot. A fracture that disturbs the joint (inter-articular fractures) can cause damage to multiple bones and the cartilage between, and could have long-term effects including arthritis and chronic pain.

Calcaneal fractures are usually caused by traumatic events: big falls, car accidents and the like. Like other stress fractures, calcaneal fractures can also be caused by overuse or repetitive stress on the heel. Pain can vary, depending on whether the fracture is traumatic or not. Some patients with calcaneal fractures report not being able to put any weight on their foot, and others report pain and symptoms similar to that of plantar fasciitis (general pain growing progressively worse over a number of days or weeks). Calcaneal fractures, however, will produce pinpoint pain after pressing down on the middle or sides of the heel bone, which does not usually occur with plantar fasciitis. Additionally, in your primary assessment and to reach a correct diagnosis, your podiatrist will inquire into your recent activities (since, often, abrupt increases in exercise or sudden weight gain can cause calcaneal stress fractures), and may take an X-ray to examine the bone.

The most important thing to consider when treating calcaneal stress fracturesis the time they take to heal. Do not wait to treat stress fractures, or to visit your podiatrist for a diagnosis. If treated improperly or ignored, stress fractures will only worsen with time or reoccur, even leading to deformities that restrict motion and activity, cause arthritis and make shoes incredibly uncomfortable.

Your podiatrist and you can work together to find the proper treatment plan for your injury, which will likely include a combination of rest, immobilization with a caste or rigid shoe, avoiding the aggravating activity, ice, NSAIDs, physical therapy for rehabilitation, and surgery in extreme cases. Non-operative treatment of calcaneus fractures will range from limiting weight bearing activities and the use of crutches, limiting motion through casting, splinting or bracing for a short period of time, and range-of-motion exercises so that your muscles don’t atrophy and the blood keeps circulating to the healing area that needs it most. Be patient with your injury, as it takes time, usually around three months, to heal stress fractures. In extreme cases, or in the case that you have poor circulation or diabetes, surgical approaches for calcaneus fractures may be a good option for your injury. Be sure to discuss the benefits of surgical treatment with your podiatrist.

For an effective plantar fasciiits treatment strategy, first consult Dr. Murray and Dr. Changto target the causes of your injury. Many treatment strategies exist for plantar fasciitis, but the treatment plan that you adopt should be specific to your individual injury. Do you have flat feet, and therefore would benefit from wearing orthotics, supportive shoes and doing foot-strengthening exercises? Do you have a heel spur that is causing your plantar fasciitis? Have you increased your training too rapidly, in which case you should take some rest days until the inflammation and pain recede and then reconsider how you ramp up your training plan? And what about the surfaces that you are regularly running on? Your everyday footwear? Lifestyle changes such as sudden weight gain? Do you have other possible conditions, deformities of the foot, or injuries to which your plantar fascia may be responding? In short, there is no one-way to treat plantar fasciitis. Without considering the cause of your own injury, it is unlikely that you will heal from it without reoccurrence.

After diagnosing you with Plantar Fasciitis, your podiatrist will recommend that you temporarily slow down. Being sure not to stand for long periods of time will help your feet heal, and a reduction in activity could include easing up on a range of activities from running to walking in bare feet. Note that resting your plantar fascia does not mean stopping activity and exercise altogether – you may have to identify exercises that don’t aggravate your heel pain, but in general, mild exercise will help strengthen and stretch the muscles in your foot, and increased blood flow to the affected area will help your foot heal. You may want to try swimming, or an easy session on the elliptical. Ask your podiatrist for suggestions on mild stretching and strengthening exercises for the plantar fascia and beyond.

Your podiatrist will also recommend a variety of active treatments. First, you should seek out shoes with arch support for exercise and everyday use. Arch support could come from padding such as heel cups, footpads, shoe inserts and custom made orthotics. Night splints are incredibly effective – these keep the foot flexed and the plantar fascia in its resting position overnight, making it much easier to take the first few steps in the morning. While it may be difficult to get used to sleeping in these night splints, you will feel positive results soon after you begin wearing a night splint, making the initial discomfort well worth the effort!

Heat and ice are great aids to plantar fascia treatment. Applying a warm heating pad to your heel before exercise can relax the muscles, making them looser for exercise. After exercise, icing is recommended to reduce the inflammation and to provide pain relief. Massaging your foot by rolling it on a frozen juice can is a great trick, and will get massage and icing out of the way. Whether you use this trick or kick back to ice your feet, you should adopt a 20 minute/twice a day icing routine to reduce your plantar fascia inflammation. Your doctor may also recommend that you take non-steroidal anti-inflammatory drugs, or NSAIDs, such as Ibuprofen, Advil, Motrin or Aleve. These work by blocking enzymes that stimulate swelling to reduce the pain caused by inflammation. Once you are on the mend, your podiatrist may instruct you with how to support the arch of your foot with athletic tape, a support that may help you ease back into exercising.

In the most severe cases, boot castes may be prescribed, and even steroid shots or injections may be given. If pain continues, in very extreme cases, your podiatric surgeon may suggest surgical methods.

Note that the reoccurrence rate of plantar fasciitis is fairly high. It is easy to feel as though your plantar fascia has recovered, and frustrating when the pain resurfaces the next morning, the next month, or the next year. Note that the reoccurring pain may surprise you when you put weight on the injured foot after resting. In this case, finding a consistent preventative routine may be key for you. In general make sure your ankle, your Achilles tendon and your calf muscles are flexible and strong with stretches and strengthening exercises prescribed by your podiatrist or physical therapist. Be sure that you are not exercising with old, worn-out footwear, and that your day-shoes are supportive and well fitted (in support, size, width and cushioning), to your individual feet.

Most of all, exercise diligence with your plantar fascia care and patience with healing your plantar fasciitis – it will take some time, in some cases up to a year, but these guidelines provide success for most plantar fasciitis sufferers.

Between the structural complexity of the heel, its biomechanics and the pressure we put on it when we engage in pretty much any activity, it is clear why the heel is not invincible (as much as we wish it could be!). Most athletes and runners complain of heel pain at one time or another, and it is important that this pain is diagnosed early and accurately for quick and successful recovery. Because of the multiple causes of heel pain, the individual physiology of each foot, and the varying amounts of stress that each person puts on his or her feet, it is important that heel pain is individually diagnosed and a treatment plans are individually tailored. Consult Dr. Murray and Dr. Chang for an accurate diagnosis and treatment plan.

To understand the underlying cause of your heel pain, your podiatrist will examine your foot, consider your medical history, and in certain cases conduct diagnostic imaging studies such as X-rays or MRIs.

Treatment may vary or be a combination of surgical and non-surgical methods. Your podiatrist will most likely recommend immediate treatment to comprise of RICE: rest, ice, compression and elevation. Limiting activities is important so that your heel has the proper time to rest and rebuild the impaired tissue. Ice packs should be applied, with a thin towel between the ice and the skin, for twenty minutes at a time, several times a day in order to reduce inflammation in the affected area. Your podiatrist will point you toward the proper wrapping or splinting method for your injury, providing you with a removable walking cast or other forms of immobilization to allow your injury the time, immobilization and support required for it to heal. Lying on the couch with your foot elevated up to 15 inches above your heart is a great way to reduce additional inflammation and swelling.

NSAIDs, or non-steroidal anti-inflammatory drugs, such as Ibuprofen, Aleve and Advil, will block enzymes that stimulate swelling responses in your body, thereby reducing pain. These should be taken as indicated on the packaging label or recommended by your doctor, but always with plenty of water as NSAIDs taken in excess or not properly flushed out of your system can have harmful effects on the kidneys. If NSAIDs fail to work after a number of weeks, your podiatrist may suggest injection therapy, of corticosteroid injections, to help reduce the inflammation in your heel and to relieve pain.

Your podiatrist will most likely recommend other techniques for padding and shoe modifications, and will suggest that you avoid going barefoot as shoes can help you relieve strain from your heel and affected area. Discuss which supportive shoes with good arch supports that are appropriate for your individual foot physiology and injury or condition would be best for you to wear. Your foot doctor will also supply you with and show you how to use padding for your shoes and how to strap or tape the injured area if necessary. Over the counter and custom orthotics are often important for long-term injury prevention, especially if your injury is a result of biomechanical abnormalities (with the way you walk, or your gait, for example). Finally, you can purchase a night splint from Blue Ridge Foot and Ankle, which helps you to stretch your plantar fascia as you sleep, reducing overnight swelling and making the first steps out of bed in the morning less painful.

Non-surgical treatment may include a regimen of exercises that range from stretching to strengthening, and will usually involve work with a physical therapist. You physical therapist will work with you to stretch your calf, which will relieve strain on the affected area and assist with blood flow, which will help you recover faster. Physical therapists may also use massage techniques to increase the blood flow in the affected areas.

If all other treatment methods fail, surgery may be a viable option. Surgical methods depend on your individual condition and its severity. Consult Dr. Murray and Dr. Chang to discuss surgical treatment options.

Heel pain is hard to deal with in the long-term, because the underlying causes that led to your injury may be difficult to resolve. For a runner, the problem may be the miles you are logging, the surfaces on which you are running, your rest schedule, or even a workout that you did weeks ago. It’s possible that your running shoes are worn out, or that the problem is the shoes you wear or activities you pursue outside of running. Plantar fasciitis, for example, can be aggravated by even the most unexpected stresses, such as how you sleep or pressing the clutch in your car.

However, the good news is that most heel injuries are preventable with dedicated work – be sure to wear supportive shoes, always warm up before exercise, cool down and stretch afterward, and most of all, listen to your body. When you experience heel pain, visit Dr. Murray and Dr. Chang of The Heel Pain Center of Central Virginia. With their years of experience working with the Charlottesville and Waynesboro community, they can help you get back on your feet and on the road to recovery.

Dr. Murray and Dr. Chang’s forty years of combined experience with fitting individuals with orthotics will ensure that you receive the proper treatment. Dr. Murray and Dr. Chang have found resounding success in prescribing and fitting orthotics to fit a variety of foot types and injuries.

Determining whether orthotics are right for you

The process for getting orthotics takes some time, primarily because Dr. Murray and Dr. Chang want to make sure that orthotics are right for the health of your feet, and your purse too! A first visit will include a foot examination, as well as an examination of the shoes. The number one cause of foot pain is worn out shoes. Shoes are not made to be worn years at a time, so if you are feeling foot pain, a money and time saving strategy may be just trying new shoes and being sure to replace your shoes every 200-400 miles.

After an examination, Dr. Murray and Dr. Chang will suggest you try wearing an over-the-counter shoe insert for a couple of weeks. These inserts cost between $35 and $60, and test whether your foot needs a little extra support or more specific support from an orthotic. If pain still occurs, upon the next visit Dr. Murray, Dr. Chang and their staff will assist you with taping your foot. The tape, in addition to the over-the-counter shoe inserts, will help to redistribute weight throughout the whole foot, binding it in a way similar to an orthotic. If success occurs and pain is significantly reduced after taping and wearing an insert, Dr. Murray and Dr. Chang will most likely suggest you get fitted for a pair of orthotics. Orthotics are pricey, about $375 per pair, but if you have gotten to this point there is a strong argument that buying custom-made orthotics will save you money and pain in the long run.

The process of fitting feet for orthotics includes taking a mold of the foot in neutral position and writing an orthotic prescription based on this mold, and sending this information to specialized laboratories to be manufactured. The prescription for your orthotics will depend on your foot type, your condition or injury, and the intended purpose of the orthotic. To this effect, there are different kinds of orthotics. Orthotics are mainly grouped into two categories: functional and accommodative. Functional orthotics corrects for excessive motion of the foot, preventing pain during ambulation. Accommodative orthotics are used to distribute weight away from a painful or injured area. Dr. Murray and Dr. Chang will customize your orthotic’s purpose and fit to specific intended activities. They will consider materials used, the rigidity of the device, and the shape of the heel or head depending on the intended use of the orthotics.

Adjusting to your orthotics

The process to being wearing orthotics is gradual. It takes 2-3 weeks to work up to wearing an orthotic full time since the adjustments they make with your foot function could cause initial soreness or pain in the feet, ankles, knees or hips. It takes several months before athletes can run in orthotics comfortably. Be attentive to any pain that may surface in the initial weeks, as adjustments to your orthotics are free under a six month warrantee with the lab that makes them.

Orthotics are only as good as the shoes in which they are inserted, so sure you are wearing proper footwear that accommodates orthotics. It is important to recognize that worn out shoes will negate the work of the orthotic, and equally as important to realize that not all shoes are made to accommodate orthotics, no matter the brand, style or cost. Consult your podiatrist or local shoe store for more information on which shoes are compatible with orthotic devices.

Usually an orthotic can be used for every activity, so patients usually only need to invest in one pair. The exception is if you would like to wear your orthotics in abnormally shaped shoes, such as women’s dress shoes.

Orthotics are only helpful when used, so it is suggested to wear your orthotics continually to reduce pain and to improve your posture and alignment. Most orthotic wearers report never wanting to take their orthotics out of their shoes because they are so comfortable.

Care and maintenance

As sand and dirt can abrade against them, reducing their functional period, we suggest you wash them every two weeks with mild soap and luke-warm water, letting them dry overnight before reinserting them. If you find that your orthotics squeak, remove them from your shoes and sprinkle talcum or baby powder on them, which should prevent the squeaking.

Your orthotics will work to restore your gait, posture, and to prevent a host of injuries that could be caused by your foot condition. Despite the initial price, orthotics last for approximately 10 years, and prevent a host of conditions, from runners knee to lower back pain. They are a highly effective, cost efficient, non-invasive, and incredibly successful treatment technique.

For more information on custom orthotics, please visit our website.