Heel Pain

HEEL PAIN IDENTIFIED

Plantar Fasciitis Heel Spurs Achilles Tendonitis Sever's Disease

 

Plantar Fasciitis

What is Plantar Fasciitis?

Plantar fasciitis is an inflammation of the plantar fascia (thick band of fibrous tissue) at the insertion into the bottom surface of the heel bone. In a small percent of people a spur develops at the insertion of the plantar fascia. The pain is due to the plantar fasciitis and not the spur.

Cause

Plantar fasciitis is caused by excessive pulling and tearing of the plantar fascia. This is usually due the following:

  • Faulty foot mechanics such as abnormal pronation (feet rolling in). This causes inflammation and pain.
  • Very high arched foot (pes cavus)
  • Dropped arches
  • Direct impact injury
  • Tight calf muscles and plantar fascia

Signs and Symptoms

  • Pain in the bottom surface of the heel
  • Sometimes pain in the arch of the foot
  • Often the Pain is intense upon standing after long periods or sitting or lying down
  • Sharp stabbing pain
  • Dull ache
  • X-rays may show a heel spur. Plantar fasciitis causes the spur. The spur itself does not produce the pain.

Treatment

  • Orthoses/Innersoles - The orthotics prescribed and designed by our Newcastle podiatrists at Beyond Podiatry are made to align the foot in the correct posture. This will reduce excessive pulling and tearing on the plantar fascia and heal the tear and inflammation at the insertion into the heel bone.
  • Strapping and padding - We incorporate a strapping technique specifically for plantar fasciitis, which combines the use of padding and sports tape.
  • Trigger Point Therapy.
  • Anti-inflammatory medications - only if this does not have adverse results with the patient's current medication.
  • Rest or Reduced Activity - All weight bearing activity including sport, walking, standing for long periods should be reduced until you are pain free.
  • Ice (apply on heel for 15 to 20 minutes every day)
  • Supportive Footwear - We work with many shoe shops that specialise in shoes for painful feet and orthotics.
  • Cortisone Injections - The local injection of corticosteroids can give temporary or permanent relief. The injection should be performed under ultrasound guidance to ensure accuracy of the insertion of the needle. Patients should be aware that local cortisone injections weaken tissue and can result in further tearing of the plantar fascia. Cortisone injections will be organised as a last resort.
  • Surgery - Modern and minimally invasive surgical procedures should only be used to treat recalcitrant plantar fasciitis. Surgery will only be offered after we have exhausted all conservative treatments.

 

 

Heel Spurs

What is a heel spur? A heel spur is a bony growth under the heel bone. Heel spurs result from excessive pulling and tearing along the plantar fascia (thick band of fibrous tissue) that inserts into the bottom surface of the heel bone. This results in plantar fasciitis (inflammation at the insertion of the plantar fascia) and is the cause of the heel pain. This is usually caused by a biomechanical imbalance in the foot. Therefore, a spur is the end result of excessive pulling on the plantar fascia and not the cause of the heel pain.

 

 

Achilles Tendonitis

What is Achilles Tendonitis?

Achilles tendonitis is an inflammation of the Achilles tendon which attaches the calf muscles to the heel bone.

Cause

Excessive stress on the Achilles tendon can cause micro tears and inflammation in the tendon. In some people this stress can lead to a rupture or complete tear of the tendon.

Excessive stress on the Achilles tendon can be caused by one or more of the following:

  • Overuse injury. This is often seen in runners, and basketball, netball and football players
  • Tight calf muscles are a contributing factor
  • Over pronation (feet roll inwards) is the most common cause of Achilles tendonitis. It causes the lower leg to excessively internally rotate, placing an excessive strain on the calf muscle. This inturn over stretches the Achilles tendon resulting in inflammation and pain
  • Over supination (feet roll outwards)

Signs and Symptoms

  • Pain and tenderness in the Achilles tendon region. The pain could be on the lateral (outside), medial (inside) and/or centre of the tendon
  • Thickening of the tendon
  • Swelling around the tendon
  • Pain when walking and running
  • Pain when pushing off on toes
  • A posterior heel spur can develop in severe cases

Treatment

  • Calf muscle stretches
  • Achilles tendon stretches
  • Orthotics - The orthotics prescribed and designed by the podiatrists at Beyond Podiatry in Newcastle are made to align the foot in the correct posture. This will reduce excessive pulling and tearing on the Achilles tendon and heal the tear and inflammation in the tendon
  • Short term use of heel lifts
  • Footwear advice
  • Myofascial Therapy (Dry Needling)
  • Anti-inflammatory medication: only if this does not have adverse results with the patient's current medication

 

 

Sever's Disease (heel pain in children)

What is Sever's Disease?

Sever's Disease (Calcaneal Aphophysitis) is not a disease, but a repetitious strain injury common in children between the ages of 8 and 14 years old.

It is a common cause of heel pain, particularly in the very active child. Patients with Sever's disease complain of pain in the bottom surface region of the back of the heel. This is where the growth plate is located, and is not fully developed or calcified in a child's foot.

Cause

Sever's Disease is a repetitive strain injury caused by the following:

  • High impact injury activities and sport like netball, football, soccer, hockey, basketball, running, jumping and tennis
  • Tight calf muscles
  • Poor mechanics, structure and function of the foot
  • Excessive pronation
  • Rapid growth spurt

The above causes tension, inflammation and pain where the Achilles tendon inserts onto the calcaneus (Back/bottom surface of the heel bone).

It is important that this problem is treated and monitored until the growth plate ossifies in the heel. This could occur between the ages of 14 and 16 years of age.

In extreme cases the growth plate can become separated from the calcaneus.

Signs and Symptoms

  • Pain in the bottom surface and at the back of the heel
  • Extreme pain when the child places their heel on the ground
  • The pain is aggravated when running or jumping on hard surfaces
  • The pain is reduced when the child walks or runs on their toes

Treatments

  • Orthotics - The orthotics prescribed and designed by the podiatrists at Beyond Podiatry in Newcastle are made to align the foot in its correct foot posture. This will reduce stress and force at the site of the growth plate of the heel bone
  • Rest and Ice the heel 20 minutes before and after sporting activity
  • Calf muscle stretching exercises

 

About us

Our Newcastle Podiatrists have extensive knowledge and expertise in all areas of Podiatric treatment and are registered with the Australian Health Practitioner Regulation Agency. Our clinics are compliant with and exceed Australian Standards for sterilisation of all instruments used.