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What causes pain in the heel?
Heel pain may be attributable to multiple causes. A well known cause is Plantar Fasciitis (which will be discussed more in the next section). Other causes may include:
- Excess weight/Overweight
- Spending increased time on your feet, particularly hard surfaces
- Thinning of the fat pads in the soles of your feet and heels
- fat pad injury at the heel, injury to the heel bone (calcaneum)
- Arthritis in the ankle or heel (subtalar) joint
- Irritation of the heel nerves
What is plantar fasciitis?
The heel attaches to the ball of the foot via several tough elastic ligaments which run distally and form the arch of your foot. The Plantar Fascia, attaches the heel bone to the digits, assists in balancing the various parts of the foot as you walk. In this way it helps your foot maintain arch function in walking over uneven terrain and helps the foot to absorb shock.
Frequently, the Plantar Fascia may become overburdened and this leads to heel pain or arch pain. Specifically, this often occurs at its attachment onto the heel bone, though it may occur in the arch of the foot. This condition is referred to as Plantar Fasciitis and characteristically the pain is may be worse in the morning.
Common causes of Plantar Fasciitis:
- Repetitive stress, therefore frequently occurring in people who spend all day on their feet or are overweight.
- Ankle stifness or tightness of the Achilles tendon increase the tension on the heel.
- Many patients with Plantar Fascia exhibit a tight Achilles tendon.
- High arched (cavus) feet or flat feet are less efficient in absorbing repetitive stresses during walking and pose an increased risk for Plantar Fascia related foot pain.
- Injury to the heel bone may trigger Plantar Fascia related foot pain.
- People who suffer with Osteoarthritis, Rheumatoid Arthritis or Ankylosing Spondylitis may be at a higher risk of inflammation related to ligaments of the foot (enthesopathy), Plantar Fasciitis may present more frequently in these types of patient.
What is the treatment for heel pain?
Heel pain is usually a repetitive or overuse injury of the foot and therefore the goals of treatment is to address this problem.
- If you have a high-arched or flat foot, your podiatrist may advise an insole or custom orthotic to reduce stress on the areas of pain.
- Your Podiatrist may inject some steroid into the attachment of the plantar fascia to damp down the inflammation and reduce the degree of heel pain.
- Infrared multi-shot video gait analysis can be undertaken to establish what motion during walking or running is over stressing the affected structures and from this an insole or custom made orthotic may be designed and prescribed.
- Your podiatrist will advise you about weight loss, activity modification and appropriate footwear.
- If you have a stiff ankle or tight Achilles tendon a physiotherapist can advise on exercises for these. Stretching the Achilles tendon and plantar fascia is very effective general treatment for many patients and your Podiatrist can make the appropriate in-house referral.
- Simple pain-killers such as paracetamol or anti-inflammatory medicines can help reduce the pain. Ask advice from your podiatrist or pharmacist before taking anti-inflammatory medicines as they can have troublesome side-effects in some people.
Is this caused by A Bone/heel Spur?
Heel spurs are common in patients with Plantar Fasciitis, though they are also present in patients who do not suffer with heel pain symptoms of the foot. Heel spurs alone are not often the cause of the pain alone and as such removal is not advocated as an effective treatment for heel pain.
When should I take professional advice?
If your heel pain is affecting your normal activities and not getting better you should consult a specialist Podiatrist.
How will my Podiatrist tell what is wrong?
Your podiatrist will listen to your complaints about your heel and examine you to see what is causing the foot pain, and whether anything else has triggered the problem. If the cause of your pain seems obvious, your podiatrist may be happy to start treatment straight away.
Plantar Fasciitis is usually diagnosed clinically, though may be evaluated via an ultrasound scan.
If you still have pain after using custom insoles or orthoses and an injection (rare), your podiatrist may want to investigate your problem a bit further. If no other medical problem or cause of stress in your heel is found, a number of other treatments can be tried:
- Further physiotherapy
- Aircast boot to rest the inflamed tissues
- Only if all non-surgical treatments fail would an operation be considered
Do I need an operation?
The goal of an operation is to transect a section of the plantar fascia from the heel, reducing the stress within in it. This type of procedure is rare as it generally has a very poor outcome and the majority of patients will improve with orthotics and an injection for Plantar Fasciitis.
Updated by: Podiatrist London Kensington