Daily Heel Pain: Causes and Treatment Options

There is a point on my heel that feels like it's being pricked by a needle every day?

Hello Doctor, my mother is 62 years old and has had a slightly misaligned spine with intermittent pain for many years.
Two years ago, she underwent massage therapy, which reduced the frequency of her symptoms.
However, for the past year and a half, she has been experiencing a sharp, stabbing pain in her heel every day.
An orthopedic doctor diagnosed her with periostitis based on X-rays.
A pressure point therapist suggested that the spinal misalignment might be compressing the nerves, which could be a possible cause.
We would like to know how to treat and alleviate the stabbing pain.
Does she need surgery to correct the spinal alignment? We would appreciate your advice.
Thank you!

yu line, 40~49 year old female. Ask Date: 2006/05/17

Dr. Xu Zhenrong reply Rehabilitation

Dear Yu Line,
Regarding the interpretation of X-rays by orthopedic physicians, the so-called "heel pain" caused by inflammation of the plantar fascia is known as plantar fasciitis.
The typical symptoms include heel pain that occurs after getting out of bed in the morning, or after prolonged sitting or standing before starting to walk.
The pain is located on the inner side of the heel where it contacts the ground, and there is a distinct tenderness when pressure is applied.
After resting, walking, or standing for a period of time, the pain gradually diminishes; however, if resting for a while and then standing again, or if standing or walking for too long, the pain may gradually worsen again.
Plantar fasciitis is more common in individuals over the age of 40 who need to stand or walk for extended periods, as soft tissue loses elasticity and degeneration may occur after middle age.
It can also occur in individuals with structural abnormalities of the foot, such as flat feet or a shortened plantar fascia.
Most cases of plantar fasciitis can be improved with conservative treatment, such as physical rehabilitation.
The rehabilitation physician may prescribe oral anti-inflammatory pain medications, while physical therapists may provide treatments that include therapeutic ultrasound to enhance local blood circulation and repair injured tissues, as well as exercises to increase ankle flexibility and stretching of the Achilles tendon to reduce the chances of recurrence.
Additionally, wearing therapeutic heel pads can provide arch support and prevent the plantar fascia from being overstretched.
For those with flat feet, special insoles may be necessary to correct the alignment of the hindfoot.
Older adults are also prone to degenerative joint disease of the spine or bone spurs, which may sometimes be accompanied by scoliosis, leading to lower back pain and sciatica symptoms.
Scoliosis typically appears on X-rays as a C-shaped or S-shaped curvature of the spine.
If the curvature is mild, approximately within 25 to 30 degrees, it can often be corrected with rehabilitation exercises, posture correction, and the use of braces.
In cases of severe symptoms or continuous deterioration, surgical intervention may be necessary.
Whether surgical correction of the lumbar spine is needed requires a comprehensive professional evaluation by a spine specialist.
Therefore, I recommend taking your mother to a nearby large hospital for further examination.
The medical team at Taipei City Hospital is eager to provide you with professional assessment and treatment.
Sincerely,
Dr.
Hsu Chen-Jung
Director of Rehabilitation Medicine, Taipei City Hospital

Reply Date: 2006/05/17

More Info

Daily heel pain can be a frustrating and debilitating condition, especially when it interferes with daily activities. In your mother's case, the heel pain, described as a sharp, stabbing sensation, could be attributed to several underlying causes, including inflammation, nerve compression, or structural issues related to her spine.

Understanding the Causes
1. Plantar Fasciitis: One of the most common causes of heel pain is plantar fasciitis, which is inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot. This condition often presents as sharp pain in the heel, especially with the first steps in the morning or after prolonged sitting.

2. Bone Spurs: X-rays may reveal bone spurs, which are bony growths that can develop on the heel bone due to chronic inflammation. These can contribute to pain, particularly if they irritate surrounding tissues.

3. Nerve Compression: Given your mother's history of spinal issues, it's possible that nerve compression in the spine could be contributing to her heel pain. Conditions like a herniated disc or spinal stenosis can lead to referred pain in the lower extremities.

4. Achilles Tendinitis: Inflammation of the Achilles tendon can also cause pain in the heel, particularly if there is tightness or overuse.

5. Other Conditions: Other potential causes include arthritis, bursitis, or even systemic conditions like diabetes that can affect nerve function and lead to pain.

Treatment Options
1. Conservative Management:
- Rest and Ice: Reducing activity and applying ice to the heel can help decrease inflammation.

- Physical Therapy: A physical therapist can provide exercises to strengthen the foot and ankle, improve flexibility, and reduce pain.

- Orthotics: Custom or over-the-counter shoe inserts can help provide support and alleviate pressure on the heel.

- Stretching Exercises: Regular stretching of the calf muscles and plantar fascia can be beneficial.

2. Medications:
- NSAIDs: Nonsteroidal anti-inflammatory drugs (like ibuprofen) can help reduce pain and inflammation.

- Corticosteroid Injections: In some cases, a doctor may recommend corticosteroid injections to reduce inflammation in the heel.

3. Surgical Options:
- Surgery is typically considered a last resort after conservative treatments have failed. If the heel pain is due to a structural issue, such as a significant bone spur or severe nerve compression, surgical intervention may be necessary to relieve pressure and correct the underlying problem.

4. Spinal Evaluation: Given your mother's history of spinal issues, it may be beneficial to consult a spine specialist. They can evaluate whether her spinal alignment is contributing to her heel pain and recommend appropriate treatment, which may include physical therapy, spinal manipulation, or, in some cases, surgical intervention.

Conclusion
In summary, your mother's daily heel pain could stem from multiple factors, including inflammation, nerve compression, or structural issues related to her spine. A comprehensive approach that includes conservative management, physical therapy, and possibly further evaluation by a spine specialist may provide relief. It is essential to address both the heel pain and any underlying spinal issues to achieve the best outcome. Consulting with a healthcare provider who specializes in musculoskeletal disorders will help tailor a treatment plan specific to her needs.

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