What is heel pain:
Heel pain is not a single condition but rather an umbrella term for a group of conditions that cause pain in the heel of the foot.
Most cases of heel pain is caused by some form of repetitive stress injuries that occur at a rate faster than the body can heal them. Heel pain can also be caused by heel spurs often associated with inflammatory joint conditions such as rheumatoid arthritis.
The heel is designed to absorb the impact of your body weight when walking, running or during any weight-bearing exercises. When pain does occur it can be very disabling which in turn can affects your gait and posture.
Types of heel pain:
The following types of heel pain are not exhaustive but may help you appreciate the complexity of heel pain and why specialist advice can be helpful.
Plantar fasciitis (or fasciopathy):
This is the most common cause of heel pain, caused by damage to the plantar fascia which is similar to a ligament. The plantar fascia connects the heel bone to the toes. This condition can be caused in various ways including extensive running, walking or standing for long periods of time, especially when you have a sedentary lifestyle. In particular, a change of surface (e.g. road to track), poor shoe support, being overweight, overuse or a tight Achilles tendon, can lead to this condition. Pain is typically worst when you first stand up after a long period of rest or first thing in the morning.
Heel bursitis (subcalcaneal bursitis):
This is an inflammation of a bursa (a fluid-filled ‘cushion’) under the heel bone where the pain is typically more in the centre of the heel than that experienced with plantar fasciitis and significantly worsens during the day. With bursitis, pain can be felt at the back of the heel when the ankle joint is moved and there may be a swelling on both sides of the Achilles tendon. Or you may feel pain deep inside the heel when it makes contact with the ground. This condition can be caused following a fall from a height on to the heel.
These are firm bumps on the back of the heel, usually caused by excessive shoe rubbing in the heel area, or the thickening of the tissues associated with a tight Achilles tendon.
Tarsal tunnel syndrome (trapped nerve)
This can feel like a burning or tingling sensation under the heel and within the arch of the foot with occasional loss of sensation on the bottom of the foot. This is caused by compression of the tibial nerve as it passes the inside of the ankle. Tapping of the nerve just behind the ankle bone (known as Tinel’s test) will stimulate the symptoms of the condition.
Chronic inflammation of the heel pad:
This is caused by a heavy heel strike or sometimes a reduction in the thickness of the heel pad which can give rise to a dull ache in the heel which increases during the day.
Often caused following injuries such as falling from a height or landing on an uneven surface.
Sever’s disease (calcaneal apophysitis):
This painful condition affects young children, usually between the ages of 8 and 12, especially those who are physically active or undergoing a growth spurt. It results from inflammation of the Achilles tendon where it attaches to the heel.
When should I see a Podiatrist?
If the pain persists longer than three weeks, it is best to seek professional advice from a podiatrist, as there are many types of heel pain, each with their own different causes and separate forms of treatment.
If you experience heel pain, some simple self-care measures include:
■ Avoid wearing ill-fitting or uncomfortable shoes
■ Wear shoes with good heel cushioning and effective arch support
■ Wear a raised heel (no more than 6-10 mm higher than normal)
■ Minimise high impact exercises such as running on hard ground
■ Lose weight if you are overweight
More specialist treatments include:
Plantar fasciitis (or fasciopathy):
In the early stages resting, icing and strapping applied to alter the direction of stretch of the ligament can all help to alleviate symptoms . However, in the long term, special insoles (orthoses) may be prescribed to help the feet to function more effectively and help to reduce recurrence. More chronic cases may require anti inflammatory (always check with your GP or pharmacist before taking any new medication) and steroid injections or surgery to release the tight tissue ‘band’.
Heel bursitis (calcaneal bursitis):
Reducing friction, ice massages, appropriate padding and shock absorbing shoes and strapping will allow inflammation to settle
In the long term, a special insole (orthoses) may be necessary.
Adjustments to footwear is usually enough to make them comfortable and wearing ankle boots may help. In more serious, recurring cases, surgery may be necessary.
Tarsal tunnel syndrome:
Special shoe inserts can reduce the pressures on the nerve and may be appropriate for certain foot types whereas, on other occasions, local injections of medication to the area where the tibial nerve is inflamed may be necessary.
Chronic inflammation of the heel pad
A soft heel cushion can help this condition.
If this is suspected, an X-ray is required to confirm final diagnosis and to determine the extent of the injury and a follow-on treatment plan.
Sever’s disease (calcaneal apophysitis)
This condition is temporary and self-limiting but can be painful at the time. A temporary heel lift, rest and stretching exercises may help. Special insoles may also help.
Bromley Podiatry & Chiropody serves the following locations: Bromley, Pettswood, Chislehurst, Orpington, Beckenham, Shortland, Hayes, Sundridge & Grove Park. Please see our contact page for directions and contact details
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