Heel Pain
What is Heel Pain?
The condition 'Heel Pain' is a broad terminology to mean pain in the heel region, which could include plantar fasciitis, achilles tendinopathies or sever's disease. Plantar Heel Pain is frequently used interchangeably with plantar fasciitis, plantar fasciosis and heel spurs, although they mean different things.
The more correct term Plantar Fasciosis, refers to a long band of connective tissue called the plantar fascia, becoming thickened and undergoes degeneration to cause pain at the insertion site under the heel. This fascia extends into the arch of the foot which provides support, balance and stabilisation.
Most common symptoms include first step pain in the morning and going into a standing position after sitting for a long period of time. You may also experience sharp shooting pain if you put your heel down or a bruised sensation at the end of your work day.
Plantar heel spur on the other hand, is a bony formation under the heel but does not necessarily cause heel pain.
Risk Factors
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Age 40 years and over
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High BMI can overload and increase stress on the plantar fascia
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Flat feet or high arches can both be predisposing factors
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Occupations that spend long hours on their feet such as builders or electricians standing on ladders for a long time
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High-impact activities such as long distance running or basketball
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Worn out footwear or uneven wear patterns can affect mechanical function
Other Causes of Heel Pain
Some of the other heel pain conditions that are not plantar fasciitis include:
Nerve compression
Symptomatic compression of the nerves that run into the foot can result in nerve pain sensations such as tingling and radiating pain. This can make weight bearing activities significantly uncomfortable and difficult.
Plantar fibromatosis (Ledderhose disease)
A benign fibrous nodule within the arch of the foot that sits deep within the plantar fascia. It is often painful when palpated and can vary in size.
Calcaneal stress fracture
Stress fractures in the heel bone can occur although rare. Symptoms include inability to put heel down, bruising, swelling and intense or dull pain. It is usually due to repetitive overuse injury of the area. People with low bone density are at higher risk of stress fractures.
Heel fat pad injury
The fatty padding under the heel protects the heel bone and helps with shock absorption. Constant impact on the fat pad can result in injury to this area, contributing to plantar heel pain.
Plantar fascia tear
The plantar fascia can tear or rupture through overuse injuries or traumatic incidents such as jumping from a height. It usually presents as sharp pain under the heel or in the arch. Repetitive strain can also result in microtears of the fascia.
Heel Pain Treatment
How We Can Help You
There are many treatment modalities in the literature and it is important to note that not every foot will respond the same way due to factors such as age and activities.
The management plan for plantar fasciitis often involves of series of identifying the underlying cause, reducing the pain symptoms and strengthening of the fascia.
1. Identify
It is vital to identify the underlying causes or predisposing factors, and address them in order to establish an effective management plan.
2. Modify
Reduce the load on the plantar fascia in the initial stages by modifying activities such as less weight bearing sports.
Weight reduction in the long term will help lessen the strain on the fascia.
3. Hot/Cold
Depending on acute and chronic phases of the condition, you may require hot and/or cold therapy.
4. Medication
If the pain is not tolerable, you may require oral pain medication to manage the intensity of pain.
5. Strapping/Taping
Applying strapping tape for plantar fasciitis can temporarily reduce the stretch in the fascia. When used in combination with compression sock, it can immediately reduce pain.
6. Orthotics
Orthotics for plantar fasciitis is a well-documented treatment and the aim is to provide support, cushioning and pressure redistribution.
7. Shockwave and Laser Therapy
These are proven non-invasive yet highly effective treatments especially for chronic plantar fasciitis cases. It is used to reduce pain and repair injury over time.
8. Stretching and Strengthening Exercises
A graduated program of strengthening is essential to load the plantar fascia and calves to build strength and prevent recurrence of symptoms.
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Plantar fasciitis is the most common condition we see at Northern Podiatrist Clinic.
We are a plantar fasciitis clinic and our Podiatrists are expertly trained to provide you with a comprehensive treatment plan to address and manage your heel pain.
