Foot Pain - Heel Pain

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In severe cases, surgery may be necessary to remove or reduce the bony growth. According to one study, however, surgery was not effective for over 30% of patients and, in fact, 14% experienced a worse condition afterward. A more recent study reported that surgery cured 90% of cases, but full recovery required 6 months to 2 years. Experts advise patients to try all conservative measures before choosing surgery.

Achilles Tendinitis

Achilles tendinitis is an inflammation of the tendon that connects the calf muscles to the heel bone. It is caused by small tears in the tendon from overuse or injury and is most common in people who engage in high-impact exercise, particularly jogging, racquetball, and tennis.

People at highest risk for this disorder from these activities are those with a shortened Achilles tendon. Such people tend to roll their feet too far inward when walking, and may bounce when they walk. A shortened tendon can be due to an inborn structural abnormality, or it can develop from regularly wearing high heels.

Evidence is uncertain about the best way to treat either acute or chronic Achilles tendinitis. Some approaches include:

Treatments to Relieve Pain and Reduce Inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (Advil) may help to ease pain and reduce inflammation. It is also helpful to apply ice four or five times a day for 20 to 30 minutes. (Note: Corticosteroid injections are sometimes used, although evidence suggests they don't help very much, while also posing a risk for rupture of the tendon.)

Gentle Stretching. Gentle calf muscle stretches may also help reduce the pain and spasms. If the calf is swollen, elevating the leg is recommended. Exercise is safe when the heel is no longer swollen or tender, even if pain is still present. If pain increases with exercise, stop immediately.

Laser Therapy. Low-level laser therapy that emits energy directed at pain trigger points has helped some patients. No strong evidence supports its use to date, however.

Surgery vs. Nonsurgical Treatment. If pain continues, the ruptured tendon will require a cast and perhaps surgery. Although some experts believe a cast is sufficient in many cases, without an operation, the tendon has a 38% chance of rupturing again. Some experts suggest surgery for active persons and nonsurgical treatment for older people.

Surgery requires a long incision with a postoperative period of immobilization that can average 6 weeks. Complications can include a significant surgical scar, infection, and muscle atrophy, although surgery reduces pain and preserves foot function in the long term. Less invasive techniques are being tested. In one study, selected patients with ruptured tendons were hospitalized for about 5 days and fitted with special footgear (Variostabil that continuously raised the back of the foot). The footgear was effective for most patients, and the tendon ruptured again in only 5% of these cases.

Excessive Pronation

Pronation is the normal motion that allows the foot to adapt to uneven walking surfaces and to absorb shock. Excessive pronation occurs when the foot has a tendency to turn inward and stretch and pull the fascia. It can cause not only heel pain, but also hip, knee, and lower back problems.

Review Date: 12/04/2006
Reviewed By: Harvey Simon, MD, Editor-in-Chief, In-Depth Reports; Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).