If you’re reading this, chances are you have been putting up with heel pain for too long.
Heel pain is an extremely common complaint and one that is actually poorly understood by the medical community and general community alike.
We hear all sorts of “misinformation” in the clinic when patients present with heel pain, which actually means that they end up suffering from heel pain for much longer than they should.
If you have been told you have flat feet, a heel spur, plantar fasciitis – chances are you have been given the wrong information and your treatment won’t work, so you end up putting up with heel pain for months or even years.
When heel pain is correctly diagnosed, and treated by a heel pain expert, relief is just around the corner.
At Premier, we have written this definitive guide to heel pain to help people fix their heel pain fast.
Here are the Top 5 causes of heel pain:
1. PLANTAR FASCIITIS
Plantar fasciitis is the most common condition that causes heel pain.
The plantar fascia is a thick fibrous tissue that runs along the sole of your foot from your calcaneus (heel bone) to your metatarsal joints (just before your toes). It functions to support the arch of the foot during gait (walking), to prevent the arch from collapsing. The plantar fascia may become inflamed and develop microtears due to many reasons. This is termed plantar fasciitis.
This is a term that much of the population knows, so we have listed it here. However, there is a more correct medical term, which is plantar fasciosis. Plantar fasciosis may involve acute or chronic stretching, tearing, and degeneration of the plantar fascia at its attachment site. It implies that it is a degenerative condition, not just an inflammatory condition. This is an important distinction because the treatment is very different. If you have been diagnosed as having plantar fasciitis and you still have heel pain – chances are it is not fasciitis (inflammation) but a fasciosis (degenerative condition), and you have not had the right treatment for it.
Common symptoms of plantar fasciosis include:
– pain on the bottom of the heel that is often felt upon weight bearing after rest, such as when taking your first – steps in the morning or when standing up after prolonged sitting.
Sometimes the pain can spread towards the toes or be more along the undersides of the foot. The pain can be so severe that people cannot put much weight on the foot when first getting out of bed
– ice application, anti-inflammatory medications for temporary relief of pain (a frozen water bottle is great for ice massage)
– footwear modification/orthotics to realign the foot
– stretching the foot and calf muscles (important to do the calf as well)
– minimising aggravating activities until it settles, such as going barefoot, or thongs
– ‘Low dye’ taping technique, which can give immediate relief
– strengthening the plantar fascia and calf area if it’s been an ongoing problem
The best exercise is below:
– its essentially a calf raise of a small step, with the toes resting on a rolled-up towel to put the plantar fascia on full stretch
– 2 x 12 reps as tolerated
2. ACHILLES TENDONITIS
Tendonitis causes inflammation of the Achilles tendon and is the result of overuse or trauma to the Achilles, the large cord-like tendon that attaches to the back of the heel bone. This is an acute condition (fast onset) due to a forced injury or sudden overload of exercise. Generally happens in younger, more active people.
Treatment for tendonitis
– anti-inflammatory medications
– heel wedges can be helpful in the short term
– gentle stretching of the calf and Achilles after 48 hrs after the initial injury
– walking and gradual return to sports
– strengthening exercises such as calf raises 1-2 weeks post-injury, progressing to more aggressive exercises such as jumping and lunging
3. ACHILLES TENDONOSIS
Tendonosis is more of a chronic ( long-term) condition affecting the Achilles tendon and is more likely to be the cause of your problem if you have had it for more than a few weeks, and are older ( 30+).
The pain is usually located at the part of the tendon that is slightly above the heel bone, although this can also cause pain directly at the insertion of the tendon on the heel bone ( the same location as Achilles tendonitis)
Achilles tendonosis often causes nagging pain that may take months or longer to resolve without proper advice and treatment
Treatment for tendonosis
– rest from aggravating activities if possible for 3-7 days to allow sensitivity to settle
– gradual and progressive rehabilitation program to strengthen the calf / Achilles complex and any other muscles in the lower limb that needs to be strengthened.
– your rehabilitation program needs to continue well after the pain has gone to continue to strengthen your Achilles so it doesn’t come back again approx 12 weeks.
– your Achilles tendonosis may be caused by weakness in other areas such as the thigh or gluteal muscles or overloaded by improper technique, so it’s important to get these other areas checked, otherwise it will come back again.
Isometric holds: for when the Achilles is acutely painful
Slow heavy loads: calf raises – 3 sec up and 3 sec down x 8 x 3 sets every second day
4. HEEL SPUR
The words plantar fasciitis and heel spur are often used interchangeably, and while they don’t really mean the exact same thing, they often are used to describe the same problem. Often X Rays are ordered and a heel spur is seen which is not normally present.
Often if something is on an x-ray that is not normal, it can be interpreted as the cause of your symptoms. Heel spurs do not cause pain, but they are a silent symptom of ongoing traction strain to the plantar fascia. Essentially over time, the plantar fascia pulls on the bone so much that it causes it to develop a heel spur.
The treatment is the same as for plantar fasciosis.
5. HEEL BURSITIS
Heel bursitis, both retrocalcaneal and retro Achilles, are common types of bursitis and can cause pain in the foot just above the back of the heel. Bursitis of the heel causes pain and swelling when the bursae at the back of the heel become irritated or inflamed. Because of the symptoms, heel bursitis is often confused with problems in the Achilles tendon.
Problems with the Achilles tendon can cause bursitis in cases where repeat irritation and stretching occur at the tendon. However, bursitis may occur with a completely normal tendon. Ultrasound may be useful here to differentiate between tendonitis and bursitis.
FACT: If you have been having heel pain for weeks or months the above home remedies will be helpful but they won’t fully resolve your heel pain. These are first-line strategies to help give relief from pain.
If you want to get better faster, Dr Liam can accurately assess and diagnose your condition and give you a tailored plan for complete resolution.