Trust me, you aren’t the only one! It is one of the most common problems I see. The best way to combat this problem is to attack it with full force…as soon as possible. Heel pain can have many different causes. The patients that generally suffer most from this condition are the ones on their feet a lot. Continuous standing; walking on a daily basis; starting a repetitive activity, such as a new exercise routine, without proper shoes, can put a lot of stress and strain on the ligaments in the foot. It eventually results in inflammation and pain.
The good news is, heel pain is treatable. If treatment is sought early, all but a small percentage of affected patients will experience relief with conservative therapies. These include: limiting activities, footwear modifications, and stretching exercises. Procrastination can cause the pain to become not only chronic, but debilitating as well.
Major Causes of Heel Pain and Their Treatment
While there can be many reasons for heel pain, generally it is categorised into four major causes: plantar fasciitis, Achilles tendonitis, bursitis and nerve pain. Diagnosing the specific issue depends on the exact location of the pain and how the pain affects the mechanical movement of the leg.
Plantar fasciitis – This is the most common cause of heel pain. It’s an inflammation of the band of tissue (the plantar fascia), that extends from the heel, to the metatarsal heads. When patients suffer from this ailment, the fascia becomes irritated and then inflamed, resulting in heel pain or pain in the arch of the foot. Plantar fascia pain is a tell-tale sign that there are mechanical issues going on in how the foot works. We typically treat plantar fasciitis first with non-surgical strategies, such as stretching exercises; rest; footwear modifications; orthotic devices; night splints and injection therapy. While most patients respond well to conservative treatments, some require surgery to correct the problem. The injection therapy is something that would have to be administered by your GP, as it is not something that falls within my scope of practice.
Achilles tendonitis – Also known as inflammation of the Achilles tendon, can also be a cause of heel pain. We often see this “overuse” condition in athletic patients who play high-impact sports, like basketball or tennis. They often have a sudden increase of repetitive activity involving the Achilles tendon, which puts too much stress on the tendon too quickly, leading to micro injuries. To treat this condition, you can immobilise the foot with a walking boot or cast, along with physical therapy application, orthotics, and ice to help repair the tendon. If the tendon is severely damaged, or if nonsurgical treatments don’t work, surgery may be necessary.
Bursitis – Another cause of heel pain commonly seen, is where the “fat pad” of the heel exhibits redness and swelling from inflammation of the small fluid-filled sac inside the heel, called the bursa. The bursa, which protects the heel from friction, can become inflamed from repetitive motion or irritation from shoes. In the case of bursitis, the heel and the toes are most often affected. Treatment may include resting the foot, ice, anti-inflammatory drug therapy, padding, and corticosteroid injections to reduce the inflammation and relieve pain. Surgery may be necessary if conservative methods do not provide relief.
Nerve pain – Is a somewhat less common cause of heel pain. When the nerves are involved, it feels more like a burning or electrical pain, shooting or radiating down the foot from the heel, typically towards the toes. A patient will often tell me their heel “burns.” There are medications that may help with nerve pain, but in this instance, the patient tends to need nerve decompression surgery, a procedure to help “untrap” the nerve. These patients tend to have several misdiagnoses, before they visit with a specialist to correctly remedy their pain.
Whatever your heel pain, I always encourage people to see a podiatrist or orthopaedic surgeon for a proper diagnosis. We specialise in the lower limbs, and our training helps us to effectively get to the bottom of what is ailing our patients. When conservative therapies do not provide relief after several months, steroidal injections are the next step. If still no relief, surgery may be considered.
Your feet mirror your general health . . . cherish them!