SYDNEY HEEL PAIN CLINIC

What is heel pain?

When it comes to problems of the foot, heel pain is a common complaint. Heel pain can be quite debilitating for some people and can often prevent them from going about their daily activities comfortably. The pain may be felt underneath the base of the heel, at the back of the heel, or toward the sides. Pain symptoms can vary from sharp and sudden to dull and achy, depending on the causative condition.

What causes heel pain?

Heel pain is most typically caused by plantar fasciitis, although Achilles tendonitis, bursitis and heel pad syndrome are other common causes. In young patients aged between 8 and 14 years, the cause is most often Sever’s disease.

Heel pain caused by plantar fasciitis

The most common cause of heel pain in patients is plantar fasciitis. Plantar fasciitis is the inflammation of the plantar fascia ligament, which runs along the base of the foot, connecting the heel to the toes. Inflammation may be due to injury or overuse. Patients with heel pain due to plantar fasciitis usually experience pain that is worse in the morning or after a period of rest. Once the patient starts walking, the pain usually subsides. The heel pain caused by plantar fasciitis is usually described as a stabbing pain in the centre of the heel.

Heel pain caused by Achilles tendonitis

Another common cause of heel pain is Achilles tendonitis: the inflammation of the Achilles tendon. The Achilles tendon is located at the lower part of the back of the leg, connecting the calf muscles to the heel bone. Tight muscles and overuse are common causes that lead to Achilles tendonitis. The heel pain caused by Achilles tendonitis is usually felt at the back of the heel. Sometimes, there is also swelling and redness at the site of the inflammation.

Heel pain caused by heel bursitis

Bursae are small, fluid-filled sacs that are located between muscles, bones and tendons to reduce friction. When the bursae located at the back of the heel become inflamed, heel pain is caused by bursitis. This can happen due to pressure from tight footwear or from impact to the area. Sometimes heel bursitis is associated with Achilles tendonitis. The pain is felt at the back of the heel of affected patients, and typically gets worse as the day goes on.

Heel pain caused by heel pad syndrome

Heel pad syndrome occurs when the fat pad (corpus adiposum) at the bottom of the heel becomes thin, worn or inflamed, causing heel pain at the centre of the base of the heel. Patients tend to experience a deep, dull aching that they often describe as a bruise. The pain is typically made worse by walking barefoot on hard surfaces. Common in the ageing foot.

Heel pain caused by Sever’s disease

Sever’s disease is the most common cause of heel pain in children and adolescents aged between 8-14 years old. It is more common in children that regularly participate in physical activity. The pain is due to the inflammation of the growth plate of the heel bone due to overuse, a growth spurt or traumatic injury. Patients with Sever’s disease find that the heel pain is worse during exercise, especially during activities that involve jumping or running. They often limp and have a tendency to tiptoe.

Some other possible causes of heel pain include:

• Heel bone stress fracture
• Baxter’s nerve entrapment
• Arthritis
• Bone bruising.

In fact, there are many more conditions that can also cause heel pain. Those listed above are the conditions more commonly seen in patients, however the list is not exhaustive. It is important to consult with your specialist sports podiatrist for a correct diagnosis of the cause of your heel pain.

How is the cause of heel pain diagnosed?

Your sports podiatrist has a wealth of knowledge when it comes to diagnosing heel pain. Your consultation will typically begin with a discussion with your specialist. They will want to know about your medical history, about the type of pain you are experiencing and when it occurs. Your sports podiatrist may make enquiries about:

• Your gender and age
• What your daily occupation entails
• Your exercise history and current participation in physical activity
• How you describe the type of pain you are experiencing
• Whether it is better or worse with particular activity
• Whether you have suffered any injuries to your lower limb recently or in the past
• Whether you are currently taking any types of medications.

Your sports podiatrist will then conduct a thorough physical examination. They will palpate (physically feel) your ankle and foot for any abnormalities and to determine what triggers your heel pain. If only one heel is painful, your sports podiatrist will compare your feet for differences in structure, range of motion and strength.

In some situations, your sports podiatrist may order an xray or ultrasound to allow them to exclude certain conditions with similar symptoms, and therefore aid in the diagnosis of your heel pain.

Biomechanical assessment in diagnosing heel pain

As part of the diagnostic process in determining the cause of your heel pain, your sports podiatrist may wish to conduct a biomechanical assessment or gait analysis. This is a fantastic diagnostic tool as it allows your specialist to identify imbalances or weakness in your lower leg and foot, and any subsequent suboptimal gait patterns because of this. Through this process, your sports podiatrist is able to identify which parts of the foot are under the most stress as you walk or run, providing clues as to what types of overuse syndromes or injuries you may be susceptible to. The assessment itself is relatively straightforward: removable markers are placed on particular points of your lower leg and foot. A camera and software are used to conduct a motion analysis while you walk on the treadmill. The technology allows your sports podiatrist to view the alignment of the structures in your and ankles and feet as they strike the treadmill.

How is heel pain treated?

The cause of your heel pain will determine the types of treatments that are suggested. Treatment options vary considerably for the different causes. It is therefore imperative that you do seek the medical opinion of a qualified sports podiatrist before commencing any type of remedies. Your sports podiatrist will be able to structure an appropriate treatment plan once they have made a sound diagnosis on the cause of your heel pain.

Some types of treatments commonly used in patients with heel pain include:

• Modification of activity: you may be recommended to modify your current physical activity or even rest completely to allow affected tissues to heal
• Maintain a healthy body weight: if you are overweight or obese, the weight of your body will be placing extra pressure on your feet and contributing to your heel pain. Losing excess weight is beneficial for treating both the cause and the symptoms of conditions causing heel pain
• Cold therapy: ice packs can be used against the painful heel for 20 minutes at a time throughout the day to reduce inflammation
• Footwear: your sports podiatrist can assist you in choosing shoes for daily activities or for exercise that will appropriately support your foot, to help reduce heel pain and allow healing in the short and longer term
• Heel pads and inserts: your sports podiatrist may recommend customized heel pads or inserts if they are appropriate for your condition. These may assist you in managing your heel pain by providing cushioning / control and support for the heel
• Sports tape: correct application of sports strapping tape will assist in supporting the heel and provide you relief from heel pain whilst allowing the causative condition to heal
• Extracorporeal shockwave therapy (ESWT): high-frequency sound waves can be directed into the painful area using a hand-held device. This process is beneficial in accelerating the healing of damaged tissues. ESWT also has an analgesic effect, stimulates blood flow and helps to break down scar tissue.
• Physical therapy: your sports podiatrist will be able to suggest which types of exercises are applicable and beneficial depending on your condition. Stretching and strengthening the lower leg, ankle and foot assists with long-term pain management and prevention. It is imperative that you follow your prescribed exercise program correctly, as not doing so may worsen your condition
• Medications: NSAIDs (non-steroidal anti-inflammatory drugs) might be advised for you to use in the short-term as a last resort. This is usually only necessary in patients with severe pain, where other conservative approaches have not worked. NSAIDs are not a long-term solution to heel pain.

Please be informed that the content detailed in the article above regarding heel pain is for informational purposes only, and should not be taken as general advice. If you are experiencing heel pain or discomfort, you should make an appointment with a qualified sports podiatrist to discuss your concerns. Appointments with our specialist sports podiatrists can be made online at sydneyheelpain.com.au or by calling 02 93883322.

Karl Lockett – sports podiatrist.