Heel Pain: Separating the myths from the legends
There have been a few injuries that have stumbled through the clinic doors this month, the most common being heel pain. Today we will talk about pain coming from the bottom of the heel, the bit you stand on, which is not to be confused with pain coming from the Achilles tendon that lies at the back of the heel.
Heel pain is one of the most widely written about injuries and there is an amazing amount of information available on the Internet regarding its causes and treatments. As a podiatrist, it is one of the most frustrating to treat as it can take many months for it to resolve (12 – 18 months in a lot of cases) and requires compliance of you the patient to follow all instructions.
Plantar heel pain is often referred to as heel spur syndrome. This is because when a patient presents with heel pain, common practice is to x-ray the foot and this commonly shows a bony growth called a heel spur.
On x-ray images, the spur looks like a spiky bony growth and therefore seems to be the obvious cause of the discomfort. In actuality, the heel spur is more often a shelf shape, rather than a hook.
So where is the pain coming from?
Usually it’s coming from an injury to a soft tissue structure called the plantar fascia that attaches to the heel bone exactly where the spur has formed. So a heel spur indicates high tension and recurrent injury to the plantar fascia while the pain is due to overloading of the structure.
Research has found that the pain is not due to an inflammatory response and although antiinflammatories can help in some very painful cases, it is unknown how exactly they help.
What causes heel pain?
Some of the first questions we ask our heel pain patients are regarding their occupation, activities and, most importantly footwear.
There is not always a well-defined episode of activity or trauma that caused the heel pain. It can begin innocently enough as a slight ache at night or a little tenderness when standing following periods of rest but don’t be fooled into thinking it will disappear on it’s own!
The cause is most likely due to multiple factors, which may include:
Occupation (amount of standing and walking during a work day)
Travel to and from your occupation (walking to public transport/car park)
Footwear worn during ALL of the above
Mechanics of walking and running
Systemic factors such as high cholesterol, menopause and an increased susceptibility to pain.
What does treatment involve?
Often a change in footwear is enough to reduce the pain initially.
Usually treatment will include both footwear assessment and advice and also calf and foot exercises, icing and massage, strapping, shockwave therapy and sometimes orthoses.
Injury to the plantar fascia requires time and patience to resolve. You must be prepared to work hard at getting better!