Symptoms

The common cause of heel pain is inflammation in the plantar fascia (this is the connective tissue in the foot).  

• The pain most frequently presents in the side or bottom rear of the heel and it can be associated with heel spurs,  heel bursitis and Achilles heel pain (Achilles Tendonitis or Achilles Tendinopathy). If accompanied by sharp heel pain, then we consider the possibility of Tarsal Tunnel Syndrome. 

• Under the sole of the foot, there is a large ligament, which begins at the heel bone and inserts into the ball of the foot.  When circumstances* present that cause excessive pulling on that ligament then eventually it causes the ligament to separate from the heel. This happens ‘fibre by fibre’ and the gradual tearing of this ligament eventually leads to an inflammation.  

• If the injury causes a calcium build up. This is the body’s response to try to glue the detached fibres back onto the heel. But eventually this results in the formation of a ‘bone spur’. 

• The bone spur itself has no nerve endings and doesn’t hurt, but upon inspection of the x-ray showing the bone spur the podiatrist may see this as a sign that the painful inflammation has been present for quite some time. Inflammation of this plantar fascial ligament is called Plantar Fasciosis, which is more commonly known as Plantar Fasciitis and is what causes pain in most cases.

What Common Circumstances Lead to Heel Pain?

• Abnormal flattening of foot arches (excessive pronation) causing overloading 

• High arched/rigid feet that generate tractional forces on the plantar fascia.

• Increased activity level  -  especially if exercising loads have changed recently

• A sudden injury or tearing of the plantar fascia similar  to an ankle sprain

• Weight gain that can lead to overloading

• Changes in footwear, which alters the weight bearing forces on the plantar fascia

• Nerve entrapment may be a contributor

What is the treatment for heel pain?

Treatment for heel pain and heel spurs must involve treatment of the symptoms as well as the pain and its cause. 

So the podiatrist will:

• Address the inflammation

• Correct the mechanical misalignment that is causing excessive strain or abnormal tractional forces on the plantar fascia of the foot. If these symptoms are present it is an absolute necessity if long term benefits are the goal. Different treatments are available depending on the exact cause of heal pain, but orthotic devices are one of the most commonly used options. 

TREATMENT FOR ACUTE INFLAMMATION 

• Calf stretches can help if performed in the right manner. We advise on a stretching and strengthening program specifically designed for the treatment of plantar fasciitis and heel pain.

• Ice massage can assist in the short term.  Panadol, Aspirin, N.S.A.I.D’s can also help short term along with Anti-inflammatory gel massage, but these are temporary measures and not a long term solution.

• Exercise before getting out of bed and before arising from rest.   An “Activity evaluation” is important. 

• Always use shoes or supportive footwear - No barefoot walking!  Footwear Assessments may have some answers. Have shoes evaluated for effectiveness by your podiatrist. 

PREVENTING RECURRENCE

• Orthotic devices may address abnormal forces or strain on the plantar fascia.

• Taping for the feet can be helpful in the shorter term

• Extracorporeal Shock Wave Therapy (ESWT)

• Foot Mobilisation

• Night braces may also be required

• Dry Needling/Western Medical Acupuncture may be considered in some cases

• Steroid injections under ultrasound are rarely required but sometimes considered in resistant cases.

Answering your questions and concerns, about heel pain is essential to your recovery. Why?   Because most people, once they know the essential reasons for each element of their treatment., will be more likely to follow through with them. 

Take the first step!