Heel Pain

There are many heel pain conditions, all of which can vary in severity, ranging from mild and intermittent to severe and debilitating. Seeing a Podiatrist to help identify which type of heel pain you have is helpful as each condition requires a different treatment approach. Knowing what is causing your heel pain helps to speed up the recovery process. These are the most common heel pain conditions we see;

Plantar fasciitis (fasciopathy)

This is probably one of the most common foot pain conditions we encounter in our clinic. It’s a degenerative condition of the plantar fascia which is a band of tissue on the sole of the foot that connects the ball of the foot with the heel. The attachment point of the fascia at the heel bone can become painful due to compression or tensile forces. This is most often noticed when getting out of bed in the morning or when standing after rest. It is thought that several things can contribute to this condition starting, including a change in activity levels, unsuitable footwear, foot function, hormonal changes and even stress. Recovery times can vary depending on how long you’ve had the condition, and the severity of your symptoms. Treatment is based on each person’s individual needs and will vary depending on how active you are, what the contributing factors have been and what activities you plan to return to as you begin to recover.

Management of plantar fasciitis often begins with changes to footwear and avoiding time barefoot. Your Podiatrist may put supportive strapping on your foot that you can reapply at home every 2-3 days. We may suggest orthoses (in-shoe supports) which help reduce the forces on the plantar fascia by altering the foot’s movements. Other treatments such as exercises, shockwave (a type of massage delivered in bursts by a machine) or steroid injections may be offered depending on your progress and individual needs.

Achilles tendonitis (tendinopathy)

Achilles tendinopathy can affect people of all ages and activity levels from the very sporty to those that lead a sedentary lifestyle. Problems usually begin following a change in activity, perhaps an increase in running volume leading up to an event or a new walking regime to boost weight loss. The tendon that runs from the calf area at the back of the leg into the heel bone becomes overworked as it tries to adapt to the new demands. Changes can then occur in the structure of the tendon, either where it is attached to the heel bone (insertional), or further up towards the calf muscle (mid-portion) which then leads to general stiffness and soreness, particularly after rest.

Management of this condition is very individual, and several factors will be considered when your Podiatrist formulates your treatment plan. It’s quite likely that your treatment will begin with some activity modification, but rarely requires you to rest unless your symptoms are very acute. If your condition has been a result of an increase in walking or running, we may suggest adding swimming or cycling into your fitness regime instead until the tendon can adapt over time. Wearing the wrong footwear can also contribute to an increase in strain on the tendon, so we are likely to want to discuss this with you and possibly make suggestions about alternatives. It’s very likely that your Podiatrist will advise an exercise program that focuses on gradual strengthening of the tendon and calf muscle to help it to adapt to increasing loads over time. Sometimes heel raises or orthotics (in-shoe devices) will be prescribed, but often only temporarily. Shockwave can also be helpful with this condition as it is thought to stimulate healing of the abnormal section of the tendon. Achilles tendinopathy improves with the right management, but can take several months to resolve fully.

Bursitis

A bursa, or fluid filled sac that lies between the bones, tendons and muscles can become irritated or inflamed, leading to bursitis. There are two forms that might occur in the back part of the heel region, the retrocalcaneal bursa between the Achilles and heel bone, and the retroachilles which lies between the Achilles and skin. Both are a result of pressure or friction, either from footwear or internal structures. A bursa that occurs on the underside of the heel is called policeman’s heel and can produce similar symptoms to plantar fasciitis.

Bursitis can be a result of several factors and may be related to overuse of the heel, particularly in very active people. Certain footwear with a hard heel counter can sometimes lead to localised irritation, as can a bony spur or overgrowth on the back of the heel. You may notice an area protruding, swelling and redness or stiffness with movement. Sometimes, bursitis can coexist with Achilles tendinopathy.

In the acute stage of heel bursitis, ice and anti-inflammatories are helpful in reducing the levels of pain and inflammation in this region. You may be advised to modify your activity levels to help reduce stress to the area and a change in footwear may also be helpful. Your Podiatrist may suggest in-shoe supports (orthoses) or heel raises and an exercise program to address any weakness in the leg or ankle muscles. Weight loss may also need to be considered with this condition. Shockwave can also help speed up the healing process. Occasionally, if your symptoms are not responding, you may be offered a steroid injection or surgery if there is an underlying structural issue.

Stress fracture

Stress fractures are small, hairline fractures that can develop in the heel bone, otherwise known as the calcaneus. These fractures result from repetitive or excessive stress rather than a single traumatic event. They are a type of overuse injury more commonly seen in athletes and individuals who engage in activities that put repetitive stress on the heel. There is usually a history of increased activity levels in the lead up to symptoms beginning, or a change to a higher impact type of activity such as jumping. Wearing inadequate footwear or having certain biomechanical features may predispose you to this condition. Low levels of certain hormones or vitamins may affect your bone density and reduce its ability to withstand repetitive forces. If your Podiatrist suspects a stress fracture, you will be advised to rest and to wear a special boot to reduce forces on the heel. A gradual return to your previous activities will be possible once the cause of the stress fracture has been identified.

Nerve compression

Sometimes, a nerve called ‘Baxter’s’ nerve can become compressed or irritated in the heel region. This often leads to a burning sensation, shooting pain and numbness on the underside of the heel. It can sometimes run alongside plantar fasciopathy, making it a little more challenging to treat. An x-ray will help to identify if the cause is due to a bone spur protruding from the heel. A steroid injection is often helpful in managing this condition.

How is heel pain diagnosed?

Firstly, your Podiatrist will spend time listening to your symptoms and the history surrounding the condition. Information about your general health and lifestyle will be needed, even stress levels and how well you sleep. It is important to take time with this step, as it can highlight valuable information that gives your Podiatrist clues about the type of heel pain condition you have and help formulate an individualised treatment plan specific to your needs and goals.

An examination of your legs and feet will allow your Podiatrist to focus on any areas of pain as well as look at the movement in various joints and the strength or flexibility of certain muscles.

Diagnostic ultrasound can be very helpful in highlighting areas of pathology within the heel, although it won’t necessarily show all the detail needed to reach a diagnosis, so your Podiatrist may recommend an alternative form of imaging such as an MRI. At Rushden Podiatry we can offer diagnostic ultrasound which helps to speed up your care and ultimately gets you back doing those things you love….as soon as possible.

Case Study – Nigel the golfer

Nigel came to see me about pain he had been having in one of his heels for a few weeks. This had started off as a minor niggle during golf but had now worsened to the point that Nigel was no longer able to play his usual 18 holes. This was making life rather miserable for him as he relied on golf as his main social and physical activity. After talking to Nigel about his symptoms and taking a look on ultrasound, it was concluded that he was likely to be suffering from plantar fasciopathy. We started off his treatment by making sure that his selection of footwear was appropriate and offering adequate support. Strapping was applied to his foot which Nigel could replace himself at home. He cut back on the golf a little for a couple of weeks whilst the strapping was taking effect and we then introduced off the shelf orthotics. A week later Nigel was doing much better and was improving enough to return to his previous activity levels on the golf course. 6 weeks later and Nigel is virtually pain-free and enjoying all 18 holes of golf again!

Book Appointment

Free Consultation