Heel Problems

Fracture of the Heel Bone

The calcaneus is the bone in the back of the foot, commonly referred to as the heel bone. This bone helps support the foot and is important in normal walking motions. The joint on top of the calcaneus is responsible for allowing the foot to rotate inwards and outwards.

Calcaneus fractures are almost always the result of high-energy injuries. They usually occur as a result of a fall from a height, such as falling from a ladder. Other causes of a calcaneus fracture include automobile accidents and sports injuries such as long distance running. Some calcaneus fractures can be associated with other injuries to the bones of the thigh, leg, or even the spine.

Calcaneus fractures cause significant swelling and pain of the back of the foot. Symptoms of a calcaneus fracture include:

• Inability to walk
• Swelling of the foot
• Bruising of the foot
• Severe heel pain

Most calcaneus fractures are closed injuries, meaning the skin is intact. When the skin around the calcaneus fracture is broken, this may represent an open, also called a compound fracture . An open fracture of the calcaneus is a surgical emergency. Calcaneus fractures may be treated in a cast or surgery may be recommended. If the calcaneus fracture is not out of position, a cast will be recommended. Non-operative treatment is also recommended in patients who have poor circulation or diabetes; these patients are at especially high-risk for developing complications from surgery of the foot. Patients who are smokers also have a very high risk of complications related to surgery for a calcaneus fracture.

Haglund's Deformity

Haglund's Deformity is a painful enlargement on the back of the heel bone that becomes irritated by shoes. It normally appears as a red, painful, and swollen area in the back of the heel bone.

Haglund's deformity is often called "pump bump" because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, any shoes with a rigid back, such as ice skates, men's dress shoes, or women's pumps, can cause this irritation.

To some extent, heredity plays a role in Haglund's deformity. Inherited foot structures that can make one prone to developing this condition include:

• A high-arched foot
• A tight Achilles tendon
• A tendency to walk on the outside of the heel.

Changing shoes, soaking feet and anti-inflammatory medications often mitigate the symptoms of this problem.

Plantar Fasciitis (heel spur)

Plantar fasciitis is a very common condition resulting in pain under the heel which often radiates into the foot.

Symptoms of the plantar fasciitis include a gradual onset of pain under the heel which may radiate into the foot. Tenderness is usually felt under and on the inside of the heel which is initially worse first in the morning but eases as the foot warms up only to return later in the day or after exercise. Stretching the plantar fascia may be painful.

Your health care provider will often recommend these steps first:

• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation
• Heel and foot stretching exercises
• Night splints to wear while sleeping to stretch the foot
• Resting as much as possible for at least a week
• Wearing shoes with good support and cushions

Other steps to relieve pain include:

• Apply ice to the painful area. Do this at least twice a day for 10 - 15 minutes, more often in the first couple of days.
• Try wearing a heel cup, felt pads in the heel area, or shoe inserts.
• Use night splints to stretch the injured fascia and allow it to heal.

If these treatments do not work, your health care provider may recommend:

• Wearing a boot cast, which looks like a ski boot, for 3 - 6 weeks. It can be removed for bathing.
• Custom-made shoe inserts (orthotics)
• Steroid shots or injections into the heel

Sometimes, foot surgery is needed.