Heel Pain

Heel pain is one of the most common of foot complaints. Symptoms include a burning type pain first thing in the morning when you get out of bed but eases after taking a few steps. You also may be experiencing pain after sitting down for a while & then standing again. 

What is happening? You have strained or bruised a ligament (plantar fascia) under the heel & arch of the foot. You may not recall an actual incident that caused the pain because heel pain generally a long-term problem. It is generally caused by your foot flattening excessively when standing or walking & causing the ligament or plantar fascia (heel pain may also be known as plantar fasciitis) to become over-stretched & eventually bruised.  

Symptoms:
It may be hard to pinpoint just when the pain in your heel began. You might have noticed it for several days. Then, as you get out of bed one morning, the pain may seem stronger than before. It feels like a dull ache most of the time and feels like the heel has been bruised.

Lifting your heel, reducing the pressure upon it, gives temporary relief. But if you continue applying weight to the heel, pain increases: it can be mild or, in the worst case, make walking unbearable.

The problem is called plantar fasciitis (plantar – sole of the foot; fascia – band; itis – inflammation). It is also called heel spur syndrome. Simple treatment often brings relief, but there is no quick cure, so patience is essential.  

Cause:
Think of your heel as a cushion. It contains columns of fatty tissue that allow the pad to retain its contour despite the repeated impact of walking or running. The shock absorber design also protects underlying structures within your foot. One such structure is called the plantar fascia. It is a dense, fibrous band that extends from the bottom of your heel bone to the under surface of your toes.

The pain comes from an inflammation or tear in the plantar fascia at the point where it attaches to the heel bone. Although an injury can lead to heel pain, there rarely is a clear cause and effect association.

Heel pain can take the form of a sharp, burning or aching sensation. In most cases, the pain occurs on only one heel, although both feet can be affected. Men and women seem to be equally vulnerable: most patients are middle- aged people who tend to be overweight.  

How is Plantar Fasciitis Diagnosed?
Since there are several causes for heel pain, we need to pin point the exact location of the pain and it is necessary to do a thorough examination to rule out disorders such as neuritis, arthritis and tendonitis.

X-rays may show a bony spur arising from the surface of the heel  at the site where the plantar fascia is attached. About half of those individuals with heel pain have no spurs, and 15% of normal adults without heel pain do have spurs. The spur itself is most often not the problem. The problem is more common among people with flat feet. The picture below shows an x-ray & a heel spur.

HOW DID THIS HAPPEN?
The plantar fascia stretches across the arch of the foot. When some of us walk our feet have a tendency to roll inward, toward each other, in a motion called pronation. When feet pronate, they flatten, stretch out and the arch elongates. This causes excessive pulling on the plantar fascia and its attachment to the heel bone begins to separate. The ligament progressively tears off the heel, fibre by fibre, causing bleeding. Over time the body lays down scar tissue, in an attempt to ‘glue’ the detached fibres back on to the bottom of the heel bone. Over the course of 3-5 years, the scar tissue calcifies, and this deposit eventually becomes visible on x-ray as a heel spur. The inflammation of the plantar fascia is what causes the pain, not the bone spur as it has no nerve endings and doesn’t hurt.

There are several reasons why this can occur. Recent weight gain and increased level of activity often start an episode. A change of shoes from well supporting walking or athletic shoes to floppy sandals can do it. When the arch of the foot collapses the plantar fascia is continually stretched preventing the inflammation from subsiding. Finally, conditions, like osteoarthritis or rheumatoid arthritis can cause this.

There is another, less common reason and that is heel pain due solely to a loss of the protective fat pad cushion we mentioned early on. All tissue atrophy or get thinner as we get older. The thinned heel fat pad permits bruising, as our body weight is concentrated over the area of the heel.

TREATMENT:
There are numerous options in treating heel pain yourself. Listed below are different alternatives. What works for one, often does not help another. Persistence is required but should there not be an obvious improvement within a month, see a Podiatrist. Further alternatives include medications such as anti-inflammatories & cortisone injections. This treatment often only treats the pain & not the underlying cause. Medication should only be used for a short period.

Footmed has treated thousands of people with heel pain. As individuals, we are all different & therefore what helps with one person, may not help another. We treat you as an individual & tailor your treatment plan accordingly to provide you with the greatest relief possible.

Private health insurance generally covers a percentage of the cost of Podiatric consultations. Podiatric consultations are also covered under Workcover, 3rd Party Insurance & Veterans Affairs.  

[THIS INFORMATION IS OF A GENERAL NATURE & SHOULD NOT BE TAKEN AS A DIAGNOSIS. SEEK ADVICE FROM A PODIATRIST FOR SPECIFIC ADVICE]