Heel pain is one of the most common conditions that a Podiatrist will see in practice.
The heel is specialised part of the body designed to absorb the impact of the body weight whilst walking, running or undertaking any form of exercise. When pain does develop, it can be disabling, making every step problematic which in turn affects your overall posture and your ability to walk.
Most cases can be caused by a mechanical injury caused by a small repetitive traumas that occur at a rate faster than the body can heal them or even by a digestion inflammatory disorder like IBS. This is the most important factor in a Podiatrists treatment plan, is to find out the cause of heel pain, proceeding onto treating and resolving the problem but
also preventing a repeat of the problem.
If you experience any foot care issues which do not resolve themselves naturally within three weeks, then consult a Podiatrist. They are the most qualified people to deal with foot problems, early treatment is vital to hasten recovery and ensure optimal outcome.
There are various types of heel pain, listed below are the most common ones
This is the most common heel pain complaint we see in clinic. It is an inflammatory condition of the plantar fascia caused by micro tearing of the tissues of the fascia which connects to the heel bone. It is an overuse injury caused by running/walking/standing for long periods of time, especially when you are not conditioned to that activity. A change of surface (eg. road to track), poor shoe support, being overweight, sudden stretching of your sole as well as a tight Achilles tendon can aa be causative factors.
Plantar Fasciitis presents as severe pain in the heel in the morning after the first few steps out of bed, or when standing up after sitting for long periods of time. The pain can appear to subside after being on your feet but returns later on that day.
This condition takes time to recover from and establishing the causative trigger is important to a resolution. The sooner it is addressed the quicker it will heal, sadly the longer it has been present it will take a bit longer to resolve. However, once the cause has been established the chance of reoccurrence in minimised.
Achilles tendonitis presents as pain, swelling, stiffness and weakness in the tendon and is especially worse after exercise or at the end of the day. The tendon is an important part of the leg and is found behind and above the heel, it joins the heel bone to your calf muscles and it helps to bend the foot downwards. It is often caused by overuse when the Achilles tendon is placed under more pressure than it can cope with. Inappropriate Footwear can also be a cause especially if the footwear is not suitable to the activity. Small tears can develop along the tendon alongside inflammation and in some cases can lead to tendon rupture. Other causes can be arthritis and in some cases long term use of some antibiotics.
Achilles tendonitis will eventually clear of its symptom’s within 3-6 months of conservative treatments. Surgical repair of the tendon might be an option, only if the symptoms do not clear.
This condition presents with tissue damage and inflammation of the Retrocalcaneal Bursa located at the back of the heel casing pain and swelling. Stiffness in the ankle can be present and it can be associated with Achilles tendonitis or an Achilles injury. The pain is often worse with rest or after any activity and will be more painful usually that night or the next morning. Limping is common at this point! I can be caused by inappropriate footwear that is too tight at the back of the heel, excessive exercise activity with inadequate recovery periods. Overweight is a contributing cause with poor core stability.
Retrocalcaneal Bursitis will settle down initially after treatment but will take 3-6 months to eventually clear.
The fat pad located underneath the heel does a great job of absorbing the forces of heel strike when walking, it shock absorbs the forces from the ground with every step. The fat pad could thin due to age or bruised by injury, Diabetes and Rheumatoid arthritis conditions may also be associated with this problem. It makes walking painful as the lack of fat on this area will put more pressure on the underlying nerves and blood vessels.
A bruised fat pad will recover in 4-6 weeks but atrophy of the fat pad will require constant protection from the footwear and padding.
This is a condition where the ligaments of the ankle have a partial or complete tear due to a sudden stretch or twisting of the ankle. The pain initially can be very severe and can feel like a ‘pop’. The area immediately swells with fluid and can often be difficult to move.
For minor sprains recovery can be several days but severe sprains can take months to completely resolve
This condition affects children between 8-14 years of age and is a painful inflammation of the heels growth plate. This becomes painful due to repetitive stress on the growth plate of the heel bone. Symptoms include pain in the back or the bottom of the heel, limping, walking on the toes and difficulty in running or jumping.
Sever’s is caused by overuse which causes stress on the heel bone generally with participation in high intensity sport being a causative factor. Sports like football, netball and running are susceptible to this problem by the pounding on a hard surfaces irritating the growth plate of the heel and surrounding soft tissues.
This condition will resolve with the right treatment plan and when the growth plate eventually closes.
This condition is an injury caused by overstretching or rupturing the posterior tibial tendon leading to symptoms of weakness, foot deformity and tendon inflammation. The tendon runs along the inside of the ankle and down the inside of the foot to just underneath the arch.The tendon along with others is one of the major supporting structures of the foot, once it is unable to do this job the foot has an appearance of a collapsed arch and looks like a ‘flat foot’.
This condition is caused by an inherited abnormality, obesity, diabetes, inflammatory diseases or excessive forces applied to the foot by a change in occupation or training for an event.
Its symptoms include pain and swelling on the inside of the ankle which increases in intensity during an activity, eventually the pain will move to the middle of the foot and can switch over to the other side of the ankle. Being unable to stand on your toes is also a symptom and the foot starts to look flatter than it once was.
This condition takes time to recover with conservative treatment – usually about 4-6 months, with surgery that increases to 12-18 months
The sinus tarsi is a small cavity containing ligaments and a joint capsule. This structure may be injured following an ankle sprain or can be associated with a ‘flatfoot’ type foot. It is painful on the outside of the ankle and there may be some swelling. It feels worse in the morning with pain and stiffness and may improve as the foot moves around but can also be aggravated by walking or running on uneven ground
Minor cases resolve within a few weeks if diagnosed early but if the condition has been present for a while then resolution can take several months
There are many other conditions that affect the heel, a Podiatrist would recognise them, treat them or refer for further diagnostic tests or refer to another medical practitioner for the appropriate treatment plan.