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Why do I have pain in my heel and what can I do about it?

Heel pain syndrome is one of the most common problems seen by foot doctors. It is safe to say 95% of all heel pain is caused by mechanical trauma. Factors that contribute to this include rapid increase in activity level, inadequate and improperly-fitting shoes, hard surfaces, obesity, and very high or low arches. In essence, anything that is creating unusual stress patterns for a prolonged period will result in fatigue and inflammation to the heel. With weight bearing, the foot lengthens and stretches the soft tissue attachments to the heel. This fulcrum effect results in compression and traction forces around the heel. In some cases, a bony spur develops as a reaction to such forces. Bursitis is also common and results in a fluctuant swelling around the heel. In severe cases, a stress fracture can occur. Treatment is usually twofold. First, the inflammation and pain cycle must be controlled. Your podiatrist will advise the best course of therapy for your situation. Ice/heat contrast therapy and anti-inflammatories such as ibuprofen, aspirin or stronger prescription medications are helpful. In severe cases, cortisone injections followed by deep heating ultrasound are of tremendous value in stopping the pain/inflammation cycle. Second, and most importantly, constant biomechanical control of the stress occurring around the heel and instep are essential. This includes modifying improper activity levels, padding and strapping the heel and instep to provide support, and accommodating insole liners to the shoes. Supportive shoes, such as walking or jogging shoes, are essential and should be worn at all times. In some cases specific, custom made orthotics to control the abnormal motions of the foot will be needed if the above treatments are not working. With the above protocol, dramatic improvement is usually seen within two weeks.

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