Burning pain in the heel or bottom of the foot that has a tingling or prickling quality, causes numbness, feels hot, and is worse at night may be indicative of nerve damage or a disorder affecting the nerves that supply the foot. There are many conditions that can cause this type of damage, including diabetic neuropathy, physical trauma or injuries, tarsal tunnel syndrome, autoimmune diseases, and certain infections.
If you have burning heel pain, it is suggested that you visit a podiatrist. A podiatrist can help diagnose the cause of your pain and find the right treatment for you. Many people suffer from bouts of heel pain. Our doctors can provide the care you need to keep you pain-free and on your feet.
Heel pain is often associated with plantar fasciitis. Avoid overworking your plantar fascia with very frequent running. Before exercising, be sure to stretch your calves, Achilles tendon, and plantar fascia. Do your best to stay at a healthy weight. For most people, plantar fasciitis improves within a few months of home treatments. These include resting, icing, and stretching. You can also help your plantar fascia recover by stabilizing your foot with tape. This limits the amount that the ligament can move.
A review of several studies suggested that taping your foot also offers temporary pain relief. You can use zinc oxide tape or kinesiology tape. It may take some practice, but you can tape your foot yourself and aid the recovery process. Learn how to tape your foot to help relieve plantar fasciitis. A heel spur is a hook of bone that can form on the heel bone, or calcaneus , of the foot. Like plantar fasciitis, it can develop from long-term stress on your feet.
An orthopedic surgeon or a podiatrist can diagnose a heel spur with an X-ray. Heel spurs often cause no symptoms. According to the American Association of Orthopaedic Surgeons AAOS , 1 in 10 people has a heel spur, but only 1 in 20 people with heel spurs experiences pain. Conversely, the Cleveland Clinic reports that 50 percent of people who have heel spurs feel pain because of the heel spur.
Having plantar fasciitis also increases your likelihood of forming heel spurs. You can treat heel spurs close to the same way you would treat plantar fasciitis. Rest and use ice, pain medications, and shoe inserts to reduce any symptoms.
Learn more about treating heel spurs at home. Children, like adults, may develop plantar fasciitis from overuse of the ligament or from wearing old or unsupportive shoes. Massaging the area can also help it heal. Make sure your child rests and avoids running, jumping, and standing for long periods to help their foot heal. When your child returns to their normal activities, remind them to do warmup exercises and stretches to keep the problem from returning.
Find out more about heel pain in kids. More research is needed on using nutrition to improve or prevent plantar fasciitis. However, taking these supplements may help with tissue repair and healing:. If you do decide to take supplements, always check with your doctor first. If weight gain caused your plantar fasciitis, eating a healthy diet can help you lose weight and relieve your heel pain. Here are 20 foods that can help you lose weight. You can develop chronic heel pain if you ignore the condition.
This can change the way you walk and cause injury to your:. Steroid injections and some other treatments can weaken the plantar fascia ligament and cause potential rupture of the ligament. Surgery carries the risks of bleeding, infection, and reactions to anesthesia.
Surgical fasciotomy should be reserved for use in patients in whom conservative measures have failed despite correction of biomechanical abnormalities. Heel pain may also have a neurologic, traumatic or systemic origin. Plantar fasciitis, the most common cause of heel pain, may have several different clinical presentations. Although pain may occur along the entire course of the plantar fascia, it is usually limited to the inferior medial aspect of the calcaneus, at the medial process of the calcaneal tubercle.
This bony prominence serves as the point of origin of the anatomic central band of the plantar fascia and the abductor hallucis, flexor digitorum brevis and abductor digiti minimi muscles. There is no correlation between pain and the presence or absence of exostoses, 1 and excision of a spur is not part of the usual surgery for plantar fasciitis.
Its incidence and severity correlate strongly with obesity. Most cases of plantar fasciitis are the result of a biomechanical fault that causes abnormal pronation. For example, a patient with a flexible rearfoot varus may at first appear to have a normal foot structure but, on weight-bearing, may display significant pronation.
The talus will plantar flex and adduct as the patient stands, while the calcaneus everts. This pronation significantly increases tension on the plantar fascia. Other conditions, such as tibia vara, ankle equinus, rearfoot varus, forefoot varus, compensated forefoot valgus and limb length inequality, can cause an abnormal pronatory force.
Increased pronation with a collapse produces additional stress on the anatomic central band of the plantar fascia and may ultimately lead to plantar fasciitis. Patients usually describe pain in the heel on taking the first several steps in the morning, with the symptoms lessening as walking continues.
They frequently relate that the pain is localized to an area that the examiner identifies as the medial calcaneal tubercle. The pain is usually insidious, with no history of acute trauma. Many patients state that they believe the condition to be the result of a stone bruise or a recent increase in daily activity. It is not unusual for a patient to endure the symptoms and try to relieve them with home remedies for many years before seeking medical treatment. Even in this age of modern technology, the diagnosis of plantar fasciitis is based mainly on the medical history and clinical presentation.
Direct palpation of the medial calcaneal tubercle often causes severe pain Figure 1. The pain is generally localized at the origin of the anatomic central band of the plantar fascia, with no significant pain on compression of the calcaneus from a medial to a lateral direction.
Standard weight-bearing radiographs in the lateral and anteroposterior projection demonstrate the biomechanical character of the hindfoot and forefoot, and may show other osseous abnormalities such as fractures, tumors or rheumatoid arthritis in the calcaneus. However, radiographs usually serve only as an aid to confirm the clinician's diagnosis. Palpation of the medial calcaneal tubercle usually elicits pain in patients presenting with plantar fasciitis.
Conservative treatment of plantar fasciitis should address the inflammatory component that causes the discomfort and the biomechanical factors that produce the disorder. Patient education is imperative.
Patients must understand the etiology of their pain, including the biomechanical factors that caused their symptoms. They should learn about home therapy that may relieve some discomfort and about recommended changes in daily activities, such as wearing appropriate athletic shoes with a significant medial arch while walking. Patients whose symptoms are associated with a recent increase in exercise should adopt a less strenuous regimen until the plantar fasciitis resolves.
The patient is fitted with a removable longitudinal metatarsal pad during the first visit. The clinician should skive cut or bevel this pad so that its greatest thickness is under the medial aspect of the arch, as opposed to the lateral aspect of the foot. This pad serves as a temporary medial arch support to decrease pronation during midstance of the gait cycle. Other clinicians favor placing a medial arch pad directly against the patient's skin and taping the patient's foot from a plantar medial to a plantar lateral direction using 3-in wide tape.
These temporary devices provide greater biomechanical support than over-the-counter heel cups or heel pads. Stretching the Achilles tendon is beneficial as adjunctive therapy for plantar fasciitis. The patient is instructed to face a wall with one foot approximately 6 in from the wall and the other foot about 2 ft from the wall, and then lean toward the wall while keeping both heels on the floor.
This exercise stretches the heel cord of the limb that is farther from the wall. It should be performed with both legs forward for two minutes each, three to five times daily. This stretching program should be continued for six to eight weeks, after which time the patient is reevaluated. Each night for 10 to 14 days, the patient should apply an ice pack to the plantar aspect of the heel 15 to 20 minutes before going to bed.
An alternative approach is to massage the plantar fascia with an ice block made up of water frozen in a paper cup for 15 minutes per day for two weeks. It is often advantageous for patients with no contraindication to take a nonsteroidal anti-inflammatory drug NSAID for six to eight weeks.
We believe that corticosteroid injections should be avoided in the initial treatment of plantar fasciitis; we use them only as supplemental treatment in patients who have resistant chronic plantar fasciitis after achieving adequate biomechanical control. These injections may provide only temporary relief and can cause a loss of the plantar fat pad if used injudiciously. Typically, 3. Solutions containing epinephrine are not used. Radiographic guidance of injection placement may aid the inexperienced practitioner.
Night splints that maintain the foot at an angle of 90 degrees or more to the ankle have recently been used as adjunctive therapy for plantar fasciitis.
These orthoses prevent contraction of the plantar fascia while the patient sleeps. One study 5 showed relief of recalcitrant plantar fasciitis pain in 83 percent of patients treated with such splints.
Orthotic devices are the mainstay of ongoing conservative treatment for patients with plantar fasciitis. The biomechanical factors that cause the abnormal pronatory forces stressing the medial band of the plantar fascia must be corrected.
Patients with pes cavus feet may benefit from using a flexible orthotic device with an additional heel cushion. Diagnosing the specific issue depends on the exact location of the pain and how the pain affects the mechanical movement of the leg. The most common cause of the heel pain is plantar fasciitis , which is an inflammation of the band of tissue the plantar fascia that extends from the heel to the toes.
When patients suffer from this ailment, the fascia becomes irritated and then inflamed, resulting in heel pain or pain in the arch of the foot. Plantar fascia pain is a tell-tale sign there are mechanical issues going on in how the foot works. We typically treat plantar fasciitis first with nonsurgical strategies, such as stretching exercises; rest; shoe pads and footwear modifications; orthotic devices; night splints and injection therapy.
While most patients respond well to conservative treatments, some require surgery to correct the problem.
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