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Whilst heel pain is common, it is not normal. Most often a painful heel is caused by overuse or injury. Pain can be underneath the heel or at the back of the heel and can be quite debilitating.
Pain can be caused by mechanical dysfunction, such as from a flat foot or high arched foot, as a result of overstretching or torsion of the plantar fascia (the ligament that supports the arch of the foot) or from stressing the Achilles tendon.
Pain underneath the heel is most commonly as a result of plantar fasciitis (heel spur syndrome) causing inflammation of the ligament itself or due to the presence of a heel spur. This pain is often present on rising, may ease a little with movement, and then tends to become progressively worse throughout the day with increased weight bearing.
Pain at the back of the heel is most often as a result of inflammation of the Achilles tendon (Achilles tendinitis) or due to a posterior heel spur or calcification. Pain due to these syndromes tend to become worse with weight bearing and are aggravated further by higher impact activities such as running and jumping. The area may appear swollen and feel warm and painful to touch.
Heel pain may also be due to a stress fracture, bursitis (inflammation of the normal fluid-filled sacs present to cushion and protect soft tissues around bony areas), or damage to the heel pad itself.
There are reports that heel pain due to plantar fasciitis is self-limiting, and so will resolve itself within twelve months, however, we often see people who have been suffering for years, or people whose pain is becoming progressively worse and interfering with their daily and recreational activities. These people will likely benefit from intervention.
Pain due to the other causes listed above often require intervention.
Treatments include a multifactorial approach, often including rest, ice, stretching exercises, anti-inflammatory medication where appropriate, orthotic devices to provide structural support, and footwear advice.
If these treatments do not resolve the symptoms injection therapy is often beneficial, either corticosteroid carefully placed to reduce inflammation or growth factor containing platelet-rich plasma (PRP) to help stimulate the body’s natural healing.
Surgery to release the plantar fascia, repair the Achilles tendon and/or remove any bony spurs is usually very successful in recalcitrant cases
Most concerns have more than one course of treatment. Feel free to contact us so one of our team can discuss options for your unique concern.
