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Foot & Ankle Injuries

Please note: These are general guidelines and may not be applicable to every patient. Always follow your surgeon’s specific instructions for care after surgery.

Heel pain is probably the most common complaint presented to doctors treating foot and ankle disorders. The pain commonly occurs at the plantar (walking surface) or posterior (back surface) aspect of the heel and may have several different causes. While painful heel conditions may not produce disabling or severe pain, they are typically aggravating enough to limit any walking, standing or running activities. Unfortunately, treatments can take considerable time and effort before they eliminate painful heel conditions.

Plantar fascitis

Plantar fascitis means literally inflammation of the muscle casing in the sole of the foot, the fascia. The fascia is located on the bottom of the foot, and when inflamed, can be very painful. If treated early, it can be healed. Plantar fascitis is difficult to remedy once it becomes a chronic condition. Ill-fitting shoes, work demands, running habits and foot mechanics can all cause plantar fascitis.

Symptoms

The sole of the foot hurts, often the pain occurs near the front of the heel. Because the muscle tightens at night, pain is usually the worst at first rising in the morning. The pain often is aggravated by standing, walking and especially running. Typically, the presence or absence of a "heel spur" is not significant. Between 30 and 40 percent of the general population has a "heel spur" (on x-ray) and yet, there is no pain.

Treatment

Depending on the severity of the condition, your doctor and physical therapist will determine what the best treatment is for you. Generally, for mild, non-chronic cases home therapies can be effective. The goals of the following treatment approaches are to decrease swelling, increase flexibility and promote healing of the fascia.

  • Tape and pad foot
  • In-shoe orthotic device
  • A series of three cortisone shots into the heel area
  • Anti-inflammatory medicine (by mouth, for two to three weeks.)
  • A change in shoe gear
  • Physical therapy (to include ice and stretching)
  • Night splint and/or a walking cast for three to six weeks
  • Surgery (rarely necessary)

Achilles tendonitis

The achilles tendon is the largest and strongest tendon in the body. The achilles connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). The tendon enables walking, running and jumping. Achilles tendonitis is an inflammation of the tendon and is almost always caused by overuse.

Any activity that requires a pushing off such as basketball or running can result in tendonitis. If achilles tendonitis is left untreated, the resulting scar tissue will replace the tendon, and the condition will become very difficult to effectively treat.

Symptoms

Symptoms include pain and stiffness in the back of the ankle close to the heel, especially when moving your foot. There could also be mild swelling along the tendon. Chronic tendinitis (lasting more than six weeks) can result in the breakdown and rupture of the tendon.

Treatment

Depending upon the severity of your condition, your doctor and physical therapist will determine which treatments are best suited for you. The following are common treatment approaches for achilles tendinitis:

  • Rest - remain inactive until symptoms have subsided, then gradually return to activity
  • Orthotics - wedges, heel lifts and stable shoes will help correct biomechanical imbalances, which are considered a main contributor to achilles tendinitis
  • Medications - NSAIDS (non-steroidal anti-inflammatory drugs) increase healing strength
  • Stretching - once the pain has subsided, stretching is considered the most important component in the treatment of achilles tendinitis. Stretching should be pushed until tightness is felt. If stretching becomes painful, then you are pushing to far. Wall leans (remain flat footed with knee fully extended, then lean toward the wall, slowly stretching the calf muscles and achilles tendon) are a good way to stretch the achilles tendon.
  • Electrotherapy - Ultrasound is used to help strengthen new tissue while phonphoresis is used to reduce swelling and promote healing.
  • Rehabilitation exercises - Atrophy will set in after an achilles injury. Elastic bands provide resistance during plantarflexion exercises. As strength improves toe-ups are recommended further strengthen the calf muscles.
  • Shock wave therapy - Shock wave therapy may be tried to reduce pain and promote healing of this condition. This type of energy wave treatment (i.e., strong sound waves) is often tried prior to surgery.
  • Surgery - If symptoms fail to subside after six months of conservative treatment, surgery to repair the damaged tendon becomes an option.

Calcaneal bursitis

Bursitis means an inflammation of a bursa, a sac that lines many joints and allows tendons and muscles to move easily when the joint is moving. In the heel, bursitis may cause bruise-like pain mostly on the bottom of the heel, but also at the back of the heel. This pain is most often felt at the end of the day, especially for people who spend much of their time on their feet.

Aside from pain, the common symptom of calcaneal bursitis is a baggy swelling on the bottom of the heel. There is no arch pain with this condition.

Treatment
  • Ice
  • Heel cups/cushions
  • Cortisone shots
  • Physical therapy
  • Anti-inflammatory medications

Calcaneal Apophysitis (Sever's Disease)

In this condition, the growth plate in the back of the heel becomes irritated as a result of a new shoe or an increase in athletic activity. This pain occurs in the back of the heel, not the bottom. This condition is a frequent cause of heel pain in active, growing children between the ages of 9 and 12. Although almost any boy or girl can be affected, children who participate in sports that require a lot of jumping have the highest risk of developing this condition.

Treatment

The most common treatment options for calcaneal apophysitis include:

  • Heel lift
  • Stretching
  • Ice
  • Anti-inflammatory medications
  • Orthotics (uncommon)

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 9/3/2009...#10060

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

© Copyright 2014 Cleveland Clinic. All rights reserved.