Member Case Study: Heel Pain

author : AMSSM

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The whole bottoms of my feet hurt these days. Been running for a number of years now and this is a first. Do you have any tips?

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Member Question from rc63413

Do you have any good tips that can help me train through heel bruises or help them improve more quickly? I think I am losing padding in my feet as I age or something. The whole bottoms of my feet hurt these days. Been running for a number of years now and this is a first.

Answer by Kenneth Cayce IV, MD

Member AMSSM

Plantar heel pain is common in athletes who run and bike. Below are several etiologies that cause heel pain in athletes.

Plantar Fasciitis

The most common cause of heel pain is called plantar fasciitis. Continuous or acute trauma to the heel causes microtears at the calcaneal (heel) insertion of the plantar fascia (supporting structure of the arch). Athletes present with heel pain and pain radiating to the rest of the foot. Common signs of plantar fasciitis are pain with the first steps in the morning or after rest, and pain with jumping or pushing off. Your physician may get an x-ray which can show a heel spur in 50% of athletes with plantar fasciitis. A heel spur is an extra bone that may rub against the plantar fascia of the heel. Heel spurs also occur in 15% of asymptomatic athletes. Your physician may also order a bone scan if he is concerned about a stress fracture in the heel.

Treatment of plantar fasciitis includes physical therapy focusing on Achilles and plantar fascia stretches, massage, and activity modification. Nonsteroidal anti-inflammatory medications may be useful in the acute setting. Your physician may prescribe cushioned heel cups or even a cortisone injection. I would not recommend repeated cortisone injections because it may cause atrophy of the fat pad covering the heel. Ninety-five percent of the athletes with plantar fasciitis will have complete resolution of their symptoms in 12-18 months. For the 5% of athletes that do not get relief with conservative treatment, surgical release of the fascia is an option.
 

Acute Posterior Fourchette Tear
Secondly, there is a condition called an acute posterior fourchette tear. This is a type of plantar fasciitis caused by a complete tear of the plantar fascia. This tear may cause acute pain and swelling at the site, loss of arch height, and a defect felt on physical exam. Treatment consists of the athlete be non-weightbearing until symptoms improve. Formal physical therapy can start once the athlete can bear weight on the foot and usually continues for 4-6 weeks. An arch support may help the athlete participate in sports after physical therapy.
 

Fat Pad Insufficiency
Thirdly, there is a condition called fat pad insufficiency. This is seen in older athletes or in athletes that have undergone multiple cortisone injections to the heel. Treatment includes a viscoelastic heel cup and well-cushioned shoes.
 

Black Heel
Lastly, black heel is defined as bluish-black deposits on the heel that present as horizontally arranged dots or spots within the skin. This condition occurs more often in young athletes participating in basketball, tennis, track, and other sports that require cutting and running. This is a self-limiting condition and will resolve spontaneously once the athlete rests for a certain period of time. Athletes may use heel cups, felt pads, cushioned athletic socks, and properly fitted shoes to decrease the spots and help prevent the formation of black heel.

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Kenneth Cayce IV, M.D., is a Primary Care/Sports Medicine Physician at MAX Sports Center. Dr. Cayce is currently accepting new patients. If you are interested in making an appointment, please call his office at (614) 828-4241.

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date: June 23, 2009