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Excessive Pronation

Heel pain sometimes results from excessive pronation.  Pronation is the normal flexible motion 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 fascia while jogging or running, for example.  Excessive pronation may also contribute to injury to the hip, knee, and lower back.

Disease and Heel Pain

Some general health conditions can 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 another 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.

Bone bruises and stone bruises are common heel injuries.  A bone bruise or contusion is an inflammation of the skin that covers the heel bone.  A stone bruise is sharply painful injury caused by the direct impact of a hard object or surface on the foot.

Stress fractures can occur, but these are less frequent.

Prevention

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-absorbant 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 before running or walking, and do some stretching exercises afterward.
• 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 podiatrist may perform various diagnostic X-rays, to rule out heel spurs or fractures.

Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendation, taping or strapping, or use of various shoe inserts – orthotic devices.  Taping and strapping supports the foot, placing stressed muscles in a physiologically restful state and preventing stretching of the plantar fascia.  Physical therapy my be used in conjunction with such treatments.

A functional orthotic device may be prescribed for correcting biomechanical imbalance, supporting the heel, controlling excessive pronation and stretching of the plantar fascia.  It will effectively treat the majority of heel and arch pain without the need for surgery.