Heel Pain by David Webby
Heel pain is one of the most common conditions treated by podiatrists.
75 to 80% of new patients that attend our clinic present with some form of heel pain.
The greatest occurrences of heel pain is often seen in middle-aged men and women, as the ligaments and other soft tissues start to lose their strength and vitality.
Heel pain may be seen in those who take part in regular sporting activities or those in work situations that require being on their feet a lot.
Heel pain can also occur in children, usually between eight and 13, as they become increasingly active in sporting activities, and can sometimes be associated with growth plate inflammation, such as Severs disease.
The causes of heel pain
It is common for people with flatter arches, or feet that role in too much (foot pronation), to experience heel pain. This is because pronated/flat feet can place excess stress on the ligaments (eg Planter fascia or planter foot muscles, that are attached to the heel bone. There can be other factors also associated with irritation to the heel (Calcaneal tuberosity)
The stress may also result from injury, or mechanical stress incurred while walking, running or jumping on hard surfaces, wearing poorly constructed footwear or being significantly overweight.
Certain diseases can also contribute to heel pain, such as Gout, Rheumatoid Arthritis and other Connective Tissue diseases.
Types of Heel pain:
One factor sometimes associated with heel pain is the heel spur, a bony growth under the heel bone. There are no visible features on the heel, but a deep, painful spot can be found in or around the middle of the sole of the heel.
Many people may have evidence of heel spurs Xray without any pain.
Heel spurs result from irritation of the attachment of the planter fascia to the heel, resulting in extra buildup of bone in response.
Both heel pain and heel spurs are frequently associated with an inflammation of the long band of tissue that connects the heel and the ball of the foot. The inflammation of this arch area is called plantar fasciitis.
Sometimes planter fasciitis occurs at the attachment, resulting in bleeding and swelling at the base.
Sometimes we see micro-tears along the planter fascia ligament resulting in lumps in the band of tissue, whixh we call fibrotoms.
Other causes of heel pain:
An inflamed bursa (bursitis); a small, irritated sack of fluid at the back or under the heel.
A neuroma (a nerve growth), or nerve entrapment when swelling in the area causes pressure on the nerve
Tarsal tunnel syndrome, where the tendons and nerves that pass under the ankle bone (Medial Malleolus) and are squashed against the bony body of the Talus bone.
Tibialis Posterior tendonitis. This is another tendon from a muscle that passes down through the tarsal tunnel area which can become inflamed or even detached from its bony insertion into the midfoot / Navicular bone. This muscle, which supports the arch, and can tear at it’s insertion at the Navicular bone, if there is excessive pronation forces or mechanical stress at the midfoot. The tendon can also become inflamed, resulting in tendonitis. One can also get shin splints of the muscle off the Tibia bone.
Irritation of the rear heel, commonly known as Insertional Achilles Tendonitis, can occur when the Achilles tendon, which attaches to the back of the heel, undergoes excessive mechanical stress. This is common with excessive pronation of the feet.
Bruises or stress fractures to the heel bones.
Heel pain may be the precursor for other issues relating to knee pain, Hip dysfunction, and lower back pain. Often foot pain is one symptom of mal-alignment of your body, or a Hip imbalance that can cause pressure on spinal nerves or lower back vertebra or disks.
What can you do?
If pain and other symptoms of inflammation – redness, swelling and heat – persist, you should limit normal daily activities.
Icing the area with a bag of frozen peas, 3 times a day for 15-20 minutes can help reduce inflammation. Also rolling a frozen bottle of water under the arch can also reduce inflammation.
One should also check their shoes for abnormal or excessive wear, and change if necessary.
What can a Podiatrist do for you?
Firstly, a thorough examination can point to the underlying issues that may be contributing to your heel pain.
We go through the history, symptoms, and other factors that may be underlying your condition.
Bring in your shoes, Xrays, and a list of medications, to help us assess causes. It doesn’t matter if you don’t have an Xray, which we can order if it requires further investigation.
A thorough assessment is paramount to give a bigger picture of the possible causative factors and history of your pain.
We may look at symptoms, duration, occurrence of incident, what aggravates it, previous treatments, footwear, activities, and type of work.
Assessment includes hands on assessment of your feet, palpation of areas on the feet, analysis of your gait and footwear.
It is often beneficial to bring in some of your shoes so we can assess your gait and areas of wear.
Initial treatment might involve taping or strapping to further assess the stress load on the feet/arch. Often we see a 50 to 100% relief of pain within the first few days.
The treatment plan may involve prescribing Orthotic devices to support and control your foot posture, thus reducing the stresses on your arch, and controlling foot function.
Treatment may also include stretches and strengthening foot exercises, to reduce stresses upon the feet. Hip balance exercise to improve balance is also important.
Certainly, an assessment of your footwear is important as we want to have a shoe that mimics the function of your feet. In combination with Orthotics, this is important to ensure great control of foot posture and function.
For acute conditions, anti-inflammatory medication and icing is important to reduce inflammation.
Other physical therapies may also be used, including dry needling and connective tissue release.
The above treatments will effectively treat the majority of heel and arch pain without the need for surgery.
If you are suffering from heel pain, or want advice, please ring 6229 9844 for an appointment or make an appointment online.