One of the most common causes of heel pain on the bottom of your foot is plantar fasciitis. Plantar fasciitis is pain along your heel and arch due to inflammation of the plantar fascia. The plantar fascia is a large band on the bottom of your foot that goes from the heel bone and attaches to each of the toes. This band helps support your arch as you walk. Plantar fasciitis can affect a variety of people including athletes or those who spend a lot of time on their feet at work. The pain is typically described as severe with the first couple of steps out of bed in the morning or with the first couple of steps after sitting for a long period of time. The pain generally starts to feel better as you start to take more steps, but some people also develop worsening pain or feeling of fatigue in their foot as the day goes on.
There are several different types of treatments for plantar fasciitis. One of the most important things when dealing with plantar fasciitis is supportive shoe gear. Flip-flops and flexible shoes without much support can exacerbate the condition. Also calf stretches, anti-inflammatories, and ice at the end of the day or after activities are helpful to try and calm down the inflammation. Freezing a water bottle and rolling it along your arch is a good option when it comes to icing. If these basic measures fail than steroid injections, arch supports, or night splints can also be utilized.
–Dr. Colleen Law
The posterior tibial tendon is located on the inside of your ankle and plays a major role in supporting and maintaining the arch on the bottom of the foot. Due to the high demands of the tendon with every day life, it can result in overuse of the tendon. This overuse is referred to as posterior tibial tendon dysfunction. When this occurs, patients will eventually develop a flat foot deformity and loss of arch height due to the weakened tendon no longer being able to support the arch. This condition is commonly seen in middle-aged women. Those with diabetes also have an increased risk.
The major problem with posterior tibial dysfunction is that it is a progressive disorder. This means that it will get worse overtime. The initial symptoms of the condition are pain and tendonitis; however there is normally no decrease in strength of the tendon or loss of arch at this stage. As it worsens, the tendon will develop tears and the patient will eventually end up with a decrease in the arch height and a flat foot. With early diagnosis, the progression can normally be slowed, or halted, through the use of orthotics, bracing, immobilization and physical therapy. If the dysfunction is left untreated, or progresses, then it may eventually have to be treated with surgical intervention.
–Dr. Colleen Law
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A pump bump also known as a Haglund’s deformity is another source of heel pain. Opposed to plantar fasciitis where the pain is on the bottom of the heel, a Haglund’s deformity is a type of spur on the back of the heel, which results in pain. This pain can also be associated with some Achilles tendonitis and bursitis as well. While the exact cause is not confirmed, some thoughts on how a Haglund’s deformity is formed is through differences in people’s anatomy and biomechanical causes. It is also thought that those with higher arches may be more prone to them. Haglund’s deformities can occur in all ages, but are more common in the younger and middle-aged population. So why is a Haglund’s deformity also known as a pump bump? This is because one of the major sources of pain is from the spur rubbing on the back of your shoe and the spurs are located right where the back of high heel shoes would rub, hence the name pump bump.
Haglund’s deformities can be seen on x-ray. In addition, most people can generally feel the bump on the back of their heel. Conservative treatment is generally rest with anti-inflammatories. If the patient is able to wear backless shoes, this can also help decrease the irritation of the heel. For those who have associated Achilles tendonitis and/or bursitis physical therapy can be a good option. If conservative options fail over a few months, then surgical options to remove the spur can be discussed.
–Dr. Colleen Law
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Stress fractures differ from regular fractures in that they are cracks in the bone opposed to a complete break through the bone. Stress fractures are very common in the foot and lower extremity due to the mechanical load from our bodies. In the foot they are most commonly seen in the second and third metatarsals. Overuse and repetitive forces cause stress fractures. This overuse can be from a runner who increases their mileage too quickly or from any increase in activity or change in activity.
People who suffer from stress fractures generally have pain in a very specific spot on their foot, ankle, or leg. Diagnosis can be a little tricky in that stress fractures are not seen right away on x-rays. This takes a couple of weeks to visualize and by the time it is seen on x-ray, the stress fracture has already started to heal. The healing of the stress fracture seen on x-ray is called callus formation. To get more of a definitive diagnosis of a stress fracture right away your doctor can order an MRI or bone scan.
Treatment for stress fractures is rest. If a patient was to continue their increased activity while having a stress fracture this could result in a complete fracture and would increase the recovery time. Sometimes your doctor may put you in a surgical shoe or walking boot in order to decrease the stress. Ice and elevation are also important for the recovery process. For those who wish to keep their conditioning up while recovering from a stress fracture, aqua jogging and swimming can be good options.
–Dr. Colleen Law