However, you don’t have to let heel pain keep you down. Dr. Silverman has been helping patients manage their heel pain for decades, and he can do the same for you. In today’s blog, he shares some of his professional advice on managing and preventing heel pain.

Five Ways To Combat Heel Pain

If you’re hoping to prevent or treat heel pain, here’s what we recommend:

1. It Starts With Your Shoes – First and foremost, you need to get your feet into comfortable and supportive shoes. If your shoes have little protection in the heel area, or if they have an elevated heel that is shifting how stress is dispersed across your foot, it’s a recipe for heel pain. Reevaluate your footwear and look into shoes that provide a little more protection for your heel area.

2. Limit The High-Impact Exercise – We love that you want to be active, but don’t always do the same high-impact activities, especially if your heels are the first area striking the ground during these exercises. Many runners, especially those who ramp up their mileage too quickly, will find that their heels start hurting. We don’t want you to be inactive, but swap out some high-impact exercises for activities that are less stressful on your heel, like biking or swimming.

3. Work Towards A Healthy Weight – Our feet and our heels bear the stress of our body weight, so the more you weigh, the more stress they feel with each step you take. Working to shed just a few pounds can take an immense amount of repetitive strain off your feet. Staying active and making healthier dietary choices can take a big burden off your heels.

4. Stretch – Get in the habit of stretching before athletic activity. This will help a lot of the soft tissues that help support the heel prepare for the activity to come. Stretching can help the calf, the Achilles and key muscles in the foot respond more naturally when stressed, which keeps your gait and your athletic form ideal. Better bodily mechanics ensure our heels aren’t overstressed when we’re active, so be sure to stretch before exercise and other physical activities.

5. Connect With A Doctor – Finally, one of the best ways to treat heel pain is by connecting with a physician if you’re dealing with new or worsening heel pain. There are plenty of different issues that could be causing your discomfort, and sometimes it’s best to have a professional take a closer look and pinpoint your diagnosis. From there, an individualized treatment plan can be tailored to your needs and personal goals. You don’t have to fight heel pain on your own!

For more tips on managing and preventing heel pain, or for assistance overcoming a different type of foot or ankle issue, connect with Dr. Silverman today!

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Causes Of Heel Spurs

Heel spurs are the result of a bony formation on the underside of your heel bone. Stress and pressure on the heel area are the greatest risk factors for their onset. That’s because excessive pressure on the heel and the nearby plantar fascia leads to repeated tearing and damage to the protective covering of the heel bone. As a result of the body’s natural repair process, excess bone can be produced, which can end up accumulating on the underside of the heel. Oftentimes these formations are quite small and asymptomatic, but if these bony deposits continue to develop, they can end up growing in size and irritating nearby soft tissue.

When you consider that stress and pressure on the heel are the two most common contributing factors to heel spur onset, it’s easy to see why certain activities can increase your risk of developing heel spurs. Those activities and factors include:

• High-impact exercise or athletics
• Poorly-fitting shoes
• Gait patterns or abnormalities that put extra strain on your heel
• Being overweight or obese
• Significant increase in stress on the heel area in a short amount of time

If you’re dealing with pain, sensitivity, tenderness or general discomfort in your heel area, especially if symptoms worsen with activity, consider consulting with a foot and ankle specialist like Dr. Silverman.

Treating Heel Spurs

If you are experiencing the symptoms we discussed above, take action before symptoms continue to get worse. Your heel spur won’t get better without active treatment, so the sooner you take action, the faster you can get back to walking without pain.

Specific treatment will be dictated on an individual basis, but for most patients treatment is two-fold. The first part of treatment focuses on protecting the heel area to allow healing to run its course. Limiting stress on the area or finding ways to protect the area with the help of something like a heel pad or walking boot can provide an enhanced environment for inflammation resolution. The second arm of treatment focuses on resolving the underlying issue that is putting extra strain on the heel area. Depending on your root cause, treatment could look like the following:

• Switching to a more protective and supportive shoe
• Wearing orthotic inserts or custom orthotics
• Losing weight to take stress off your feet
• Shifting athletics or exercise programs to give feet time off between high-impact activities
• Working with a specialist or physical therapist to treat walking abnormalities

The post Why Do Heel Spurs Develop? appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

Causes Of Fat Pad Degeneration

Expedited loss of the fat pads in our heels can lead to a few different foot issues, including fat pad syndrome and bone spurs in the heel. To prevent these issues and ensure every step remains comfortable, we want to shine a spotlight on four activities that may be putting excessive strain on your heel fat pads.

1. Unsupportive Shoes – We didn’t come out of the womb wearing shoes, so you certainly don’t need to wear shoes all the time in order to protect your heels. However, wearing the wrong shoe or a shoe that doesn’t provide the right support for the activity can lead to extra strain on your heel fat pad. High heels or unsupportive athletic shoes can either put added stress on certain areas of your feet or fail to provide enough protection during high-intensity activities, increasing your risk of heel fat pad loss.

2. Being Overweight – The more you weigh, the more stress that is channeled to your feet with each step you take. If you’re overweight or obese, your fat pads may degenerate faster as a result of this extra strain.

3. High-Impact Activities Without Ample Rest – We want you to exercise and challenge your body, but if you gravitate towards high impact activities and don’t give your feet enough time to recover after activity, you may be at risk of affecting the health of your heel fat pad. Box jumps and running can put additional pressure on our heels, and while they are a great way to physically challenge your body, be sure you give it some time off to recover after intense activity.

4. Watch Your Surfaces – It’s also wise to consider what surfaces you are exercising on. We understand that you’re not going to be able to take your basketball game outside to a grass surface, but harder surfaces naturally absorb less stress when we move, which puts more strain on your feet. If you’re training for a marathon or simply going for a run, consider running on a softer track surface as opposed to running on the sidewalk or road. Also, be sure to keep the above tip in mind and give your feet plenty of rest after intense activity on a hard surface as well.

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What Is Sever’s Disease?

Sever’s disease is a condition that occurs when the Achilles tendon ends up pulling on the growth plate of the heel bone. This repeated stress on the growth plate of the heel can lead to pain and inflammation, making movements like standing, walking and running quite uncomfortable. It tends to occur in physically active children between the ages of 8 and 14 years old, and discomfort typically increases during physical activity or a period of rapid growth. During a growth spurt, the bones grow faster than the tendons, increasing the pull of the tendon on the heel.

Aside from heel pain that comes and goes and may be worsened by activity, other symptoms of Sever’s disease include:

• Limping
• Walking on toes to avoid pressure on the heels
• A feeling of pressure on the back of the heel
• Swelling
• Redness

And while Sever’s disease is not all that serious, try telling that to a kid who just wants to run around with their friends without pain, or to a parent who wants to help their child find relief from their discomfort. Fortunately, with targeted treatment, many children and teens can find the pain relief they seek.

How To Treat Sever’s Disease

Treatment is pretty simple on paper, but every parent knows that it’s not always easy to get kids to follow through with commitments like physical therapy or to adhere to restrictions that have been put in place. It will take a concentrated effort from both parent and child to help them successfully overcome this condition. Odds are your foot specialist will recommend a combination of the following treatments:

Rest/Activity Avoidance – You’ll want to cut back a little on activities to provide a better healing environment for the tendon and heel. That’s not to say that children should just sit on the couch for weeks, but limit physical activities that include tasks like running and jumping, especially if symptoms start to develop.

Ice – Icing the back of the heel and the lower Achilles tendon for 15-20 minutes after activity or when symptoms develop can help to calm inflammation and swelling that could be prolonging discomfort.

Footwear Changes – Cushioned and supportive shoes are a must. Shoes that are too tight or unsupportive options can put more strain on the Achilles tendon and in turn the heel.

OTC Pain Relievers – Over-the-counter pain relievers and anti-inflammatory medications may also prove useful for calming irritation caused by activity.

Physical Therapy and Stretching – Stretching and physical therapy exercises are very important in helping your child find long-term pain relief. Stretching will help to loosen a tight Achilles tendon to decrease the pull of the tendon on the growth plate. Calf stretches through toe pointing or flexing, or by stretching up against a wall can help to take pressure off the heel’s growth plate.

The post Heel Pain In Children – What Could Be The Cause? appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

What’s Causing My Chronic Heel Pain?

If you’re dealing with chronic heel pain, especially if the discomfort is worse right away in the morning when you take your first few steps, you may be dealing with one of these three conditions:

Heel Bursitis – Heel bursitis, also classified as heel inflammation, is a common cause of heel discomfort. If chronic stress causes the bursa sac in the area to become inflamed or irritated, you’ll deal with pain, discomfort and localized swelling in the heel area. Switching to a more comfortable shoe, re-examining your activity habits and stretching before movement can all help to take stress off the heel and protect the bursa sac. Be wary of increasing your activity load too quickly, as too much stress in a short time of time is the most common reason for heel bursitis.

Achilles Tendinitis – Achilles tendinitis can develop when the large tendon that runs down the back of your leg become irritated or inflamed. This inflammation is typically the result of overstress to the area, but it could also be caused by your gait and the way pressure is applied to the tendon. Overuse is the most common cause of Achilles tendonitis, and it is treated much the same as heel bursitis, with activity modification, footwear changes and short-term rest to allow the inflammation to subside.

Plantar Fasciitis – Plantar fasciitis is another condition that is ultimately caused by inflammation or irritation of a structure, but this time it is housed in the connective tissues that run on the underside of your foot that connect your heel to your toes. When this thick band of tissue becomes inflamed or irritated, movement and pressure on the area can become painful. You’ll typically notice this with the first few steps after inactivity or as you get out of bed in the morning. Footwear changes and activity modification are helpful in combating plantar fasciitis, but physical therapy to help strengthen structures and take pressure off the plantar fascia is also immensely helpful. Surgery to correct the problem can also be performed, but most people respond well to conservative treatment.

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How Retrocalcaneal Bursitis Develops

Retrocalcaneal bursitis sets in when the bursae near your heel become inflamed. Your bursae are small fluid-filled sacs that help lubricate the area and foster healthy movement in the joint. The bursae in your heels lie behind your Achilles tendon, above where the tendon attaches to your heel bone. Swelling and inflammation of these sacs can lead to heel swelling and sensitivity.

These bursae can become inflamed due to a number of different causes, but likely the most common is overstress and overuse. Athletes, runners and dancers are all prone to retrocalcaneal bursitis, but sometimes it is misdiagnosed as Achilles tendinitis. Being overweight or wearing ill-fitting shoes can also increase your risk of developing the condition. That’s why it’s so important to get an accurate diagnosis from a foot and ankle specialists.

Symptoms and Treatment

The most common symptoms associated with retrocalcaneal bursitis is pain and discomfort in the area, especially when pressure is applied to the area. Other symptoms include:

• Visible or noticeable swelling in the heel
• Calf pain or discomfort
• Stiffness
• Redness
• Limited range of motion and flexibility in the area

Retrocalcaneal bursitis is diagnosed with a physical examination of the area and a discussion about your symptoms. Your doctor may order imaging tests to rule out a fracture or larger deformity, or they may order a fluid sample collection if they believe the pain is being caused by an infection. Most people do not need these extra tests, but they can help rule out more serious problems.

Retrocalcaneal bursitis, when caught early enough, tends to respond well to conservative treatment. Your doctor will likely recommend a combination of RICE, which stands for Rest, Ice, Compression and Elevation. They may also ask you to back off certain activities or to switch you into a more comfortable and protective footwear option. These typically help to reduce symptoms and are easy enough to do on your own if the condition returns at a later date. However, more people who actively protect the area and give it time to heal can fully put the problem behind them.

The post How To Treat Retrocalcaneal Bursitis appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

Heel Pain Won’t Go Away

Here’s a look at some of the reasons why your heel pain isn’t going away.

1. Too Much Stress – We’ll get to some of the possible underlying causes in a bit, but regardless of what’s causing your heel pain, the simple fact may be that it’s not going away because you continue to put too much stress on your feet. You need to give your heels time to rest and heal, and if they are constantly absorbing stress with each step, they can’t easily do that. We understand that it’s easier said than done to remain off your feet for a while, but do what you can and talk to your foot specialist about walking boots or other weight-bearing orthotics.

2. Bad Shoes – Your shoes could actually be contributing to your heel pain, and if you keep sticking your feet in the same pair every day, odds are that discomfort is going to linger. High heels and unsupportive flats like sandals can put abnormal stress on different areas of your feet, including your heels. Make sure your shoes are comfortable and that the inside provides amble cushioning. Otherwise consider switching shoes or adding an orthotic insert.

3. Your Weight – Being overweight can also put more stress on your feet and the natural cushioning in your heels. Over time, this added stress can lead to heel pad height loss and make bearing stress more uncomfortable. Striving to eat right and work towards a healthy weight can also help to alleviate heel discomfort.

4. Deep Heel Bruise – You’ve probably experienced the sharp pain that comes with stepping on a hard object squarely with your heel at some point in your life, whether it be a Lego or a small stone. Direct trauma to the heel from stepping on a small object can cause heel bruises, and they can linger if you don’t give the foot time to heal. Heel bruises can also develop as a result of more acute trauma, like if you fall from a great height, because oftentimes your heels are the first thing to hit the ground. We can help treat these heel bruises.

5. Psoriatic Arthritis/Plantar Fasciitis – Psoriatic arthritis can lead to tissue inflammation, and if this occurs in the feet, it can cause symptoms associated with plantar fasciitis. This involves inflammation to a thick band of tissue that connects with your heel. If you don’t actively work to resolve this inflammation, it’s likely going to linger, as will your pain and discomfort. Whether you’re dealing with plantar fasciitis or inflammation derived from psoriatic arthritis, your foot specialist can help.

The post Why Is My Heel Pain Lingering? appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

Heel Pain Causing Limp

For the sake of this blog, we’re going to focus on some of the more not-so-obvious reasons why you’re experiencing heel pain. Direct trauma from falls or hard contact on the ground can suggest a fracture that would require physician intervention, but the following conditions are a little less obvious, and thus can be trickier to manage.

1. Plantar Fasciitis – Plantar fasciitis is a condition in which the plantar fascia, the tight band of tissue under the arch of your foot, becomes inflamed. This inflammation can lead to severe pain and cause someone to try to avoid putting pressure on the area by limping. It can develop as a result of regular overuse, but can be exacerbated by other factors, like being overweight, being over the age of 40 or having high arches or flat feet. Trying to power through the discomfort tends to inhibit healing, so talk to a foot specialist if you believe you may be dealing with plantar fasciitis.

2. Achilles Tendonitis – Your Achilles tendon attaches to the back of your heel, and if it becomes irritated or inflamed, you may feel it in your heel. Oftentimes this condition develops as a result of overuse, like from running too much or too often, but it can also develop if you have poor fitting shoes that you spend hours in each day. Left untreated, pain can linger, and it can also put you at an increased risk for an Achilles tendon rupture.

3. Tarsal Tunnel Syndrome – We talk more about tarsal tunnel syndrome in this blog, but essentially it’s a condition that involves an impingement of the large nerve at the back of your foot. If pain is housed in both the heel and the front of your foot, odds are a nerve issue is at play. Consider reaching out to a foot specialist if you’re experiencing these symptoms alongside an inhibited gait or localized numbness.

4. Fat Pad Atrophy – Most adults have a nice little fat pad under their heel to help absorb pressure with every step they take. However, over time this heel pad can thin out due to repeated or intense stress. This process can also be expedited in marathon runners or those who are overweight. The lack of natural padding can make each step more painful, leading to a noticeable limp. Treatment varies from patient to patient, and a consultation with a foot specialist can help uncover the best treatment options for you.

With all of the above problems, pain is unlikely to subside if you just try to limp your way through life, so reach out to Dr. Silverman’s office to get set up with a diagnosis and treatment plan.

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As we tell each patient that we consult online, it’s best to get a diagnosis from a specialist in your area, but it may be a good idea to head into a clinic for x-rays because a number of different issues could be going on. At a minimum, you’re probably dealing with what’s known as a heel or stone bruise. As we described in this post on identifying and treating heel bruises, the fat pad on the underside of the heel can be damaged after hard trauma to the heel. It can lead to a contused, partially disrupted or completely disrupted fat pad.

The good news is that heel bruises and fat pad disruptions typically heal well with conservative care techniques. This means treatments like rest, ice, compression and elevation. Anti-inflammatory pain relievers can also help provide relief. One of the most important things about treating a heel bruise is that you give your feet enough time to heal. If you try to rush back into activity too quickly, you’re only going to be stressing your heel with every step you take, and it’s never going to heal properly. Athletes are notoriously bad at rushing back too quickly following a heel bruise, but try to find other ways to exercise that still allows your feet to avoid activity.

Calcaneal Fracture Treatment

If you suffer severe enough trauma, the calcaneus, or heel bone, can actually fracture. Things get a little trickier if you’re dealing with a calcaneal fracture because non-operative treatment has some downfalls. Without surgery, your heel can widen, poor healing can negatively affect your peroneal tendon, arthritis and joint stiffness can develop or fibula disruption can occur. That’s why we talked about the problem with avoiding surgery if you have a calcaneal fracture.

For most calcaneal fractures, surgery is the preferred treatment route. Surgery to address the fracture has three main goals:

• Fuse the fracture to prevent arthritis
• Narrow the heel to reduce peroneal tendon disruption
• Adjusting the fracture and joint to ensure proper healing

This is a difficult procedure that takes precise work from a skilled surgeon, but it’s one of Dr. Silverman’s favorite procedures to perform. Getting the fracture to heal in just the right location is rewarding for both patient and provider. Rehab after surgery follows the same path of a heel bruise in that RICE and slowly returning to activity are your best courses of action.

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Causes of Flatfeet

• Flatfeet can occur during the growth of a child through natural body developments.
• About 20% of the population suffers from flatfeet, although most individuals will have no symptoms.
• Tight calf muscles and tarsal coalition (abnormal bone growth) can also cause rigid or flexible flat feet.
• Flatfeet is usually a genetic condition.

Symptoms of Flatfeet

• A flattened foot arch that is accompanied by an outward splaying of the feet.
• General achiness in the foot, especially if the child is very active.
• A slight limp is present in some cases.
• Tightness in the calf.
• Pain in the inside region of the ankle and in the Achilles tendon.

Non-surgical treatment

As stated above, a large portion of people who suffer from flatfeet don’t exhibit any symptoms or experience foot pain.  Of the people that do experience pain, most can be treated with non-surgical options.  Your doctor will conduct what is known as a “jack test” to determine if you have flexible or rigid deformities in your feet.  Flexible flatfeet is much more common than rigid flatfeet.  Because flexible flatfeet is much more common, and because it is associated with a muscle issue as opposed to a bone issue, we’ll discuss treatment options for flexible flatfeet below.

• Calf stretching – Calf stretching is key to relieving tightness, which can cause pain in children who suffer from flatfeet.  Parents should make sure their children stretch their calf and feet each day so the muscles can stretch out before physical activity.  A good practice is to have your child stretch their legs, ankles and feet with some simple movements when they wake up each day.
• Activity Modification – Sometimes children can experience chronic foot discomfort because the muscles aren’t given ample time to heal.  A short, 1-2 week period of limited physical or sporting activities can lead to decreased irritation in the foot and calf.
• Comfort shoes and shoe inserts – Your doctor may recommend new shoes or an orthopedic shoe insert to help alleviate some of the stress your child puts on their foot.  Shoes with a slight heel can help stretch out the calf muscle as they move, and inserts can help lessen the pressure placed on the foot.  Parents should consult a specialist about each option as prolonged arch support inserts can actually weaken muscles in the foot which can contribute to the symptoms of flatfeet.

Surgical treatment

Surgical treatment of flexible flatfeet is rare, but it is an option if non-surgical options fail.

• Gastrocnemius recession – A gastrocnemius recession involves lengthening the tight portion of the Achilles tendon.  This addresses the most common cause of flatfeet.  This procedure will alleviate the pain, but it will not necessarily lead to the development of an arch in the foot, although it is possible that one may develop once the tendon is lengthened.
• Lateral lengthening – This procedure involves cutting into the calcaneus to lengthen the arch of the foot.  It is usually preformed in conjunction with a gastrocnemius recession.
• Subtalar Arthroresis – This procedure is a little controversial as it involves placing a device in the foot to shift the heel bone and create an arch.  Removal of the device is often required, but many patients develop an arch once the soft tissue heals.

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