Arthritic Heel Pain
Osteoarthritis
Osteoarthritis or degenerative joint disease is the most common skeletal joint abnormality. This type of arthritis is called “wear and tear” arthritis. This type of arthritic condition can be caused by several factors. As people get older, joints and the cartilage that lines the joints wears out. This often slow degeneration of the joints can lead to joints that are “bone-on-bone”. Also trauma or accident can predispose a patient to developing osteoarthritis, especially if a fracture has occurred.
Osteoarthritis can caused development of bone spurs, severe joint pain and disability if no treatment is performed. In the foot, there is a joint called the subtalar joint. The subtalar joint lies directly underneath the ankle joint or just above the heel bone.
In advanced stages of osteoarthritis within the subtalar joint, the cartilage is disintegrated, bone spurs develop and pain can often be manifested in the heel.
Psoriatic Arthritis
Psoriatic arthritis is an arthritic condition that occurs in patients who have an inflammatory disorder called psoriasis. Approximately 3-7% of patients with psoriasis will develop psoriatic arthritis.
Most patients who develop psoriatic arthritis are around 40 years old. Males are predominantly more likely to develop this condition. Any age can be affected. Common locations for the arthritis to manifest are the big toes, lesser toes and the calcaneus or heel bone. It should also be noted that toenail and fingernail changes can occur. Toenail specifically can develop small pits or divots. The nails can shed or flake off. The nails can become hypertrophic or very thickened and disfigured. Ingrown toenails are relatively common with this disease.
In psoriatic arthritis, the toes can become swollen and resemble “little sausages.” Inflammation can occur in the bones of the pelvis. Also the joints at the base of the toes can have what we call a “pencil-in-cup” deformity in which the metatarsal bone whithers away from a rounded, healthy bone to a sharp point like a pencil.
Rheumatoid Arthritis
Rheumatoid arthritis is an inflammatory arthritis affecting the connective tissues. The connective tissues are the tissues that connect the bones to each other. Connective tissues include joint capsules, ligaments, cartilage, etc. This disease causes wasting away of the joints as well as atrophy of the muscle and bone.
Most patients with rheumatoid arthritis have pain that is worse after periods of immobility. Stiffness and pain occurs and often subsides a little after the joint has “warmed up”. Increased or prolonged activity can lead to worsening of the joint pain. Patient have also related weight loss, fever, coldness, numbness, tingling, fatigue, and malaise. In the heel, pain is usually at the back where the achilles tendon inserts. Large prominent rheumatoid nodules can form over the back of the heel and be very tender to touch and shoe pressure.
Rheumatoid arthritis is based on having various symptoms for a certain amount of time. These symptoms include morning stiffness, painful range of motion in at least one joint, symmetrical joint swelling, painful subcutaneous nodules, x-ray changes, positive blood test (positive rheumatoid factor), changes in the joint fluid, changes in the body cells on microscope.
Gouty Arthritis
Gout is caused by an increase in uric acid in the body. Uric acid is a small crystal that is naturally found in the body, and when large amounts of this crystal are formed, they can collect in joints and cause gout. This can occur one of several ways. The most common ways in which uric acid builds up in the system is:
1. Over-production of uric acid – usually diet related
2. Under-excretion of uric acid - related to kidney disease
Gout can be acute or chronic. Acute gout usually manifests in one joint, sudden onset, and intensely painful with inflammation, redness and swelling. The joint is stiff, the patient is guarded and sometimes the skin overlying the painful becomes dry and scaly.
Chronic gout is associated with the formation of tophi. Tophi are large collections of uric acid crystals that form at joints. The tophi have a consistency of cottage cheese. The uric acid is white, chaulky, and can intensely painful. Sometimes the tophi will drain white fluid.
Diagnosis of gout is made through a clinical evaluation and examination of gouty crystals on a microscope. Some times the bones on x-ray can have changes that resemble “rat-bites”. The posterior heel at the site of the achilles tendon insertion is the most common area of manifesting gout in the heel. However, the most common joint to have gout is the great toe joint. Gout is typically treated with over-the-counter medications. If large tophi are present, these are typically excised or removed.
Ankylosing Spondylitis
The following criteria qualifies someone to have this debilitating arthritic condition:
1. Limited motion of the lower back from front back and side to side.
2. History of pain in the lower spine.
3. Unable to expand or difficulty expanding the chest or filling the chest with air
Ankylosing spondylitis is most commonly represented by having severe lower back pain, increased back stiffness, ascending back pain, heel pain, fatigue, poor vision and degeneration of the spine. Arthritis can develop so severely in the spin that it says to resemble a piece of bamboo on x-ray.
Reiter’s Syndrome
Reiter’s syndrome is defined by having three main problems: inflammation of the urethra in males and cervix in females, diarrhea, and inflammatory eye disease. Penile and oral ulceration are also common. However, in the foot, it cause the formation of a “fluffy” heel spur on the bottom of the calcaneus or heel bone.
If you feel you arthritis is the cause of your heel pain and you want a professional opinion, please contact Dr. Eric Silvers in both McKinney, Tx and Prosper, TX. Our doctors are patiently waiting to help you rid you heel pain forever. Please call 972-542-2155 to speak to our friendly staff and schedule an appointment today.
