Achillis Bursitis

Heel pain is a common symptom that has many possible causes. Although heel pain sometimes is caused by a systemic (body-wide) illness, such as rheumatoid arthritis or gout, it usually is a local condition that affects only the foot. The most common local causes of heel pain include:

Plantar fasciitis — Plantar fasciitis is a painful inflammation of the plantar fascia, a fibrous band of tissue on the sole of the foot that helps to support the arch. Plantar fasciitis occurs when the plantar fascia is overloaded or overstretched. This causes small tears in the fibers of the fascia, especially where the fascia meets the heel bone. Plantar fasciitis may develop in just about anyone but it is particularly common in the following groups of people: people with diabetes, obese people, pregnant women, runners, volleyball players, tennis players and people who participate in step aerobics or stair climbing. You also can trigger plantar fasciitis by pushing a large appliance or piece of furniture or by wearing worn out or poorly constructed shoes. In athletes, plantar fasciitis may follow a period of intense training, especially in runners who push themselves to run longer distances. People with flat feet have a higher risk of developing plantar fasciitis.
Heel spur — A heel spur is an abnormal growth of bone at the area where the plantar fascia attaches to the heel bone. It is caused by long-term strain on the plantar fascia and muscles of the foot, especially in obese people, runners or joggers. As in plantar fasciitis, shoes that are worn out, poorly fitting or poorly constructed can aggravate the problem. Heel spurs may not be the cause of heel pain even when seen on an X-ray. In fact, they may develop as a reaction to plantar fasciitis

- Calcaneal apophysitis — In this condition, the center of the heel bone becomes irritated as a result of a new shoe or increased athletic activity. This pain occurs in the back of the heel, not the bottom. Calcaneal apophysitis is a fairly common cause of heel pain in active, growing children between the ages of 8 and 14. Although almost any boy or girl can be affected, children who participate in sports that require a lot of jumping have the highest risk of developing this condition.
- Bursitis — Bursitis means inflammation of a bursa, a sac that lines many joints and allows tendons and muscles to move easily when the joint is moving. In the heel, bursitis may cause pain at the underside or back of the heel. In some cases, heel bursitis is related to structural problems of the foot that cause an abnormal gait (way of walking). In other cases, wearing shoes with poorly cushioned heels can trigger bursitis.
- Pump bump — This condition, medically known as posterior calcaneal exostosis, is an abnormal bony growth at the back of the heel. It is especially common in young women, in whom it is often related to long-term bursitis caused by pressure from pump shoes.

Local bruises — Like other parts of the foot, the heel can be bumped and bruised accidentally. Typically, this happens as a “stone bruise,” an impact injury caused by stepping on a sharp object while walking barefoot.
Achilles tendonitis — In most cases, Achilles tendonitis (inflammation of the Achilles tendon) is triggered by overuse, especially by excessive jumping during sports. However, it also can be related to poorly fitting shoes if the upper back portion of a shoe digs into the Achilles tendon at the back of the heel. Less often, it is caused by an inflammatory illness, such as ankylosing spondylitis (also called axial spondylarthritis), reactive arthritis, gout or rheumatoid arthritis.
Trapped nerve — Compression of a small nerve (a branch of the lateral plantar nerve) can cause pain, numbness or tingling in the heel area. In many cases, this nerve compression is related to a sprain, fracture or varicose (swollen) vein near the heel.

Symptoms

The heel can be painful in many different ways, depending on the cause:

Plantar fasciitis — Plantar fasciitis commonly causes intense heel pain along the bottom of the foot during the first few steps after getting out of bed in the morning. This heel pain often goes away once you start to walk around, but it may return in the late afternoon or evening.
Heel spur — Although X-ray evidence suggests that about 10% of the general population has heels spurs, many of these people do not have any symptoms. In others, heel spurs cause pain and tenderness on the undersurface of the heel that worsen over several months.
Calcaneal apophysitis — In a child, this condition causes pain and tenderness at the lower back portion of the heel. The affected heel is often sore to the touch but not obviously swollen.
Bursitis — Bursitis involving the heel causes pain in the middle of the undersurface of the heel that worsens with prolonged standing and pain at the back of the heel that worsens if you bend your foot up or down.
Pump bump — This condition causes a painful enlargement at the back of the heel, especially when wearing shoes that press against the back of the heel.
Local bruises — Heel bruises, like bruises elsewhere in the body, may cause pain, mild swelling, soreness and a black-and-blue discoloration of the skin.
Achilles tendonitis — This condition causes pain at the back of the heel where the Achilles tendon attaches to the heel. The pain typically becomes worse if you exercise or play sports, and it often is followed by soreness, stiffness and mild swelling.
Trapped nerve — A trapped nerve can cause pain, numbness or tingling almost anywhere at the back, inside or undersurface of the heel. In addition, there are often other symptoms — such as swelling or discoloration — if the trapped nerve was caused by a sprain, fracture or other injury.

Diagnosis

After you have described your foot symptoms, your doctor will want to know more details about your pain, your medical history and lifestyle, including:

Whether your pain is worse at specific times of the day or after specific activities
Any recent injury to the area
Your medical and orthopedic history, especially any history of diabetes, arthritis or injury to your foot or leg
Your age and occupation
Your recreational activities, including sports and exercise programs
The type of shoes you usually wear, how well they fit, and how frequently you buy a new pair

Your doctor will examine you, including:

An evaluation of your gait — While you are barefoot, your doctor will ask you to stand still and to walk in order to evaluate how your foot moves as you walk.
An examination of your feet — Your doctor may compare your feet for any differences between them. Then your doctor may examine your painful foot for signs of tenderness, swelling, discoloration, muscle weakness and decreased range of motion.
A neurological examination — The nerves and muscles may be evaluated by checking strength, sensation and reflexes.

In addition to examining you, your health care professional may want to examine your shoes. Signs of excessive wear in certain parts of a shoe can provide valuable clues to problems in the way you walk and poor bone alignment. Depending on the results of your physical examination, you may need foot X-rays or other diagnostic tests.

Dr FallahZadeh Comprehensicve Physical

Medicine and Rehabilitation