Hell pain. (Whoops, I spelled that wrong. Or did I?) I am actually referring to “heel” pain, of course. It is one of the more painful and annoying problems that patients come in with. I say that because it can keep you from doing what you would like, love or have to do. This includes everything from exercising, cooking, working and chasing after your kids.

Most of the time, those of us who have, or had this heel/ arch pain continue to do whatever it is we want or need to do. We just do it with less joy, sometimes much less. At times, we have stopped the activity that drives us hoping that it will either subside or go away altogether. I say “we” because I am a member of the heel pain fraternity of years ago. And although it was over 20 years ago I still recall, quite vividly, the angst of having the late night visits to the bathroom. Not because of any urinary issues, thankfully, but because of the fact that the first step down in the morning was a killer. Most times if you have to get up in the middle of the night you could do what you need to do and be back in bed almost without waking up. Not so with this.

Causes of Heel Pain

Exercising-overdoing it or doing too much too soon
Faulty or inappropriate shoewear
Faulty foot and/ or leg biomechanics
Certain medical issues that can lead to a predisposition
Trauma
Pregnancy-a lot of weight gain over a short period of time

There is so much that I would like to explain about heel and arch pain but am limited in time and space. No, not like Stephen Hawkins’ time and space, just article space. I see patients from all walks of life with this problem in almost every age category except teens and younger. So no, it’s not an age thing as some patients ask. Although for my more familiar patients I tell them that it is, just to tease them.

Allow me to briefly explain the anatomy first. There is a strong, somewhat inflexible cord (plantar fascia) on the bottom of the foot that attaches the heel to the toes and basically helps form the arch of the foot- I am simplifying this. For many reasons this cord can become over-stretched, irritated, strained or even torn. (When a structure becomes inflamed we change the ending to “itis”, i.e. tendonitis, arthritis or plantar fasciitis). It doesn’t seem to matter if you are extremely active or somewhat sedentary. Something will usually have to happen for that cord to become inflamed. I say usually because most times patients cannot recall any obvious instance which would cause the initial problem. It really begins to develop due to a change of something. And, ninety percent of the time we are unaware of anything that we have done that has changed. We have been doing the same job in the same way for 20 years, the exercise routine is the same, the shoes are the same, etc. Just because we hadn’t noticed something different doesn’t mean some change hasn’t occurred. Our bodies change constantly and the change can be attributed to aging. You can’t spell change without age.

Also, it doesn’t matter if you have a flat foot, a high arch, if you’re an electrician, a manager of a restaurant, use a treadmill or a long distance runner. There is a strain on the cord that needs to be supported. The change can be the fact that the plantar fascia can no longer support the foot during its daily activities.

For myself, I developed plantar fasciitis after college while working in NYC in a sales job. I was still running 8-10 miles 5-6 times per week as I had done for years. You would think that alone would cause it. It wasn’t. It was the fact that I was now walking in shoes on concrete sidewalks all day long. Thankfully, a pair of custom orthotics was the answer for my problem. The pain calmed down almost immediately, I began to enjoy my running again, although I still hated the job at the time. To this day I still use orthotics in everything I put on my feet.

Symptoms

Pain upon arising after short periods of rest
Swelling of the heel
Sharp pain in the bottom of the heel
Pain after exercising, not during

Treatments

NSAID’s-Motrin, Ibuprofen, Advil
Ice
Stretching
Physical Therapy
Ultrasound
Change in shoewear
Cortisone injections
Orthotics-custom-made inserts for shoes
Surgery- a last resort
Plus others that can be discussed

Okay, so what do you do if you think you may have this concern? Try to figure out what you had done that may have caused this pain to begin. Some questions I ask patients is what is their occupation, how this may have begun, what, if any, exercising are they involved in, what remedies have they tried, what worked or didn’t etc. Also, do they experience more pain during certain times of the day or with certain activities. The list above is not a complete one for treatment but does encompass some of the modalities.

Radiographs are usually taken to ascertain whether there is a fracture or another problem which may be causing all the pain. In, and of, itself a heel spur does not necessarily mean that you have plantar fasciitis, and vice versa. Or, that there is an issue at all. The spur is a reaction of the body to certain stresses placed on ligaments or tendons. Sometimes an MRI may be necessary if it appears to be warranted, although not usually.

Except for a few patients, I have not advised patients to discontinue their activity completely. I do suggest a modification of what they’re doing, or at the very least cross-training. When I experienced this problem myself, I was personally advised to stop running and take a few weeks off. Being the true runner that I was, I went home, ran 8 miles, showered and called another Podiatrist who performed a more thorough evaluation, made me custom orthotics where I experienced a decreasing level of pain which soon thereafter reached a zero level. I returned to running and racing more comfortably.

If it happens to be a job-related issue, that can and usually does mean some change, at least for a short period of time until the issue has quieted down to a more manageable level. Each patient truly is an individual case because everyone comes to the table with different backgrounds of lifestyle, job, activity level, shoe gear etc. For someone who has had the delightful experience of having hell pain (not a misspelling) I know what you’re going through. On occasion I feel the sting of a recurrence of that painful time. It’s usually something that I have done to warrant the return and what comes to mind is Physician, heel thyself.