No-Incision Treatment for Heel Pain
We are pleased to introduce extracorporeal shock wave therapy for chronic heel pain.
Similar to lithotripsy for treatment of kidney stones, this treatment utilizes high-energy
shock waves that penetrate tissue in the heel to help relieve pain and improve function by
stimulating or triggering you body's own repair mechanisms. This is a no-incision
treatment that can be done in our office, with no hospitalization required.
Heel Pain Has Many Causes
In our pursuit of healthy bodies, pain can be an enemy. In some instances, however, it is of
biological benefit. Pain that occurs right after an injury or early in an illness may play a protective
role, often warning us about the damage we've suffered.
When we sprain an ankle, for example, the pain warns us that the ligament and soft tissues may be
frayed and bruised, and that further activity may cause additional injury.
Pain, such as may occur in our heels, also alerts us to seek medical attention. This alert is of
utmost importance because of the many afflictions that contribute to heel pain.
constructed footwear; or being overweight.
constructed footwear; or being overweight.
The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a
network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside
influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes
disabling, can occur in the front, back, or bottom of the heel.
A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone.
The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch.
When there is no indication of bone enlargement, the condition is sometimes referred to as "heel
Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long
band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the
lining or membrane that covers the heel bone. These conditions may result from biomechanical
imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.
Both heel pain and heel spurs are frequently associated with an inflammation of the band of fibrous
connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the
ball of the foot. The inflammation is called plantar fasciitis. It is common among athletes who run
and jump a lot, and it can be quite painful.
The condition occurs when the plantar fascia is strained over time beyond its normal extension,
causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to
inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.
The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch
area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.
Resting provides only temporary relief. When you resume walking, particularly after a night's sleep,
you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel.
As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of
relief. The pain often returns after prolonged rest or extensive walking.
Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and
flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the
normal walking pattern.
As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then
moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming
rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward
motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons
attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to
the hip, knee, and lower back.
Disease and Heel Pain
Some general health conditions can also bring about heel pain.
- Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests
itself in the big toe joint, can cause heel discomfort in some cases.
- Heel pain may also be the result of an inflamed bursa (bursitis), a small, irritated sack of
fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be
associated with a heel spur or may mimic the pain of a heel spur.
- Haglund's deformity ("pump bump") is a bone enlargement at the back of the heel bone, in
the area where the achilles tendon attaches to the bone. This sometimes painful deformity
generally is the result of bursitis caused by pressure against the shoe and can be
aggravated by the height or stitching of a heel counter of a particular shoe.
- Pain at the back of the heel is associated with inflammation of the achilles tendon as it runs
behind the ankle and inserts on the back surface of the heel bone. The inflammation is
called achilles tendinitis. It is common among people who run and walk a lot and have tight
tendons. The condition occurs when the tendon is strained over time, causing the fibers to
tear or stretch along its length, or at its insertion on to the heel bone. This leads to
inflammation, pain, and the possible growth of a bone spur on the back of the heel bone.
The inflammation is aggravated by the chronic irritation that sometimes accompanies an
active lifestyle and certain activities that strain an already tight tendon.
- Bone bruises are common heel injuries. A bone bruise or contusion is an inflammation of
the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the
direct impact of a hard object or surface on the foot.
- Stress fractures of the heel bone also can occur, although infrequently.
Children’s Heel Pain
Heel pain can also occur in children, most commonly between ages 8 and 13, as they become
increasingly active in sports activity in and out of school. This physical activity, particularly jumping,
inflames the growth centers of the heels; the more active the child, the more likely the condition will
occur. When the bones mature, the problems disappear and are not likely to recur. If heel pain
occurs in this age group, podiatric care is necessary to protect the growing bone and to provide pain
relief. Other good news is that heel spurs do not often develop in children.
A variety of steps can be taken to avoid heel pain and accompanying afflictions:
- Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, rigid
shanks, and supportive heel counters.
- Wear the proper shoes for each activity.
- Do not wear shoes with excessive wear on heels or soles.
- Prepare properly before exercising. Warm up and do stretching exercises before and after
- Pace yourself when you participate in athletic activities.
- Don’t underestimate your body's need for rest and good nutrition.
- If obese, lose weight.
- Podiatric Medical Care
If pain and other symptoms of inflammation—redness, swelling, heat—persist, you should limit
normal daily activities and contact a doctor of podiatric medicine.
The podiatric physician will examine the area and may perform diagnostic X-rays to rule out
problems of the bone.
Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe
recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or
strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state.
Physical therapy may be used in conjunction with such treatments.
A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling
excessive pronation, and supporting of the ligaments and tendons attaching to the heel bone. It will
effectively treat the majority of heel and arch pain without the need for surgery.
Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is
necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or
removal of a neuroma or other soft-tissue growth.
Heel Pain Tips
- If you have experienced painful heels try wearing your shoes around your house in the
evening. Don't wear slippers or socks or go barefoot. You may also try gentle calf stretches
for 20 to 30 seconds on each leg. This is best done barefoot, leaning forward towards a wall
with one foot forward and one foot back.
- If the pain persists longer than one month, you should visit a podiatrist for evaluation and
treatment. Your feet should not hurt, and professional podiatric care may be required to help
relieve your discomfort.
- If you have not exercised in a long time, consult your podiatric physician before starting a new
- Begin an exercise program slowly. Don't go too far or too fast.
- Purchase and maintain good shoes and replace them regularly.
- Stretch each foot and achilles tendon before and after exercise.
- Avoid uneven walking surfaces or stepping on rocks as much as possible.
- Avoid going barefoot on hard surfaces.
- Vary the incline on a treadmill during exercise. Nobody walks uphill all the time.
- If it hurts, stop. Don't try to "work through the pain."