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Heel my Pain - Why does my heel hurt?


Heel pain is one of the most common complaints we see as Podiatrists. There are a few different reasons for heel pain. Heel Spurs, bone fractures, Bursitis, nerve entrapement ...just to name a few but the most common one we see in the clinic is Planter Fasciitis (also called Planter Heel Pain Syndrome).

It is important to get the right diagnosis for your heel pain. This will ensure you are using the correct treatment plan to help improve the ailment and not worsen the issue.


Planter heel pain syndrome (Planter fasciitis) happens when the planter fascia in the arch of the foot becomes irritated, inflamed and can also become thickened. The job of the planter fascia is to provide stability to the arch and foot while walking and acts like a lever to help with toeing off during your walking cycle (gait). It originates at the heel bone and splays into three bands that connect to the ball of the foot (Metatarsals).


The Planter Fascia

Symptoms of Planter Heel Pain Syndrome (Planter Fasciitis)

  • Pain that is usually at its worst when getting up out of bed in the morning, but typically subsides after a few minutes of walking.

  • “A stabbing and sharp pain under the heel which causes a limp” is the usually complaint we hear in the clinic

  • Pain after prolonged periods of sitting or standing

  • Pain immediately following a period of intense exercise


What are the risk factors for developing Planter heel pain

  • In the athletic population risk factors include training errors, training surfaces or faulty, worn or inappropriate footwear.

  • Long distance running

  • High Body Mass Index (BMI)

  • Age (between 40 and 70 years are at highest risk)

  • Occupation (People whose job requires long periods of standing are at higher risk)

  • Heel Spurs

  • Reduced muscle flexibility (particularly the calf muscles)

  • Foot Type - Pes Planus (Low arch) and Pes Cavus (High arch) and leg length discrepancies can all predispose to a higher risk of Planter Heel Pain Syndrome.


How is Planter Heel Pain diagnosed?

Your Podiatrist is an expert in diagnosing the problem. The diagnosis is often made based upon the patient’s presenting symptoms and clinical signs.

  1. The Podiatrist considers the patient’s exercise, medical history and lifestyle.

  2. They conduct a thorough physical examination, including palpating the foot to see if the pain can be pin-pointed or reproduced.

  3. A biomechanical analysis is carried out in most cases, to assess the patient’s gait (style of walking or running). This allows for the podiatrist to determine if there are any structural abnormalities or malalignments in the lower limb and foot that could be contributing to the patient’s heel pain.

  4. In some situations, diagnostic imaging, such as an ultrasound or xray may be required to rule out other differential diagnoses such as bursitis or bone fracture.


What are the treatment options for Planter Heel Pain?


Icing - especially after walking can help reduce pain in the area. I like to tell my clients to pop a plastic bottle of water into the freezer and use it to roll under the foot as needed.

Stretching

  • Planter fascia Stretch- A specific stretch for the planter fascia as demonstrated in the image below should be preformed 3-4 times a day. You should hold the stretch for 30 seconds, then go deeper into the stretch and hold for another 30 seconds. This should be repeated 2-3 times. This stretch should be completed before getting out of bed in the morning and as often as necessary thereafter

  • Calf stretch – The two large muscles in the calf should also be stretched as demonstrated below. Repeat 2-3 times daily


Taping – A specific type of taping for the planter fascia pain can be applied by your Podiatrist which usually provides great short term relief. It can be used for 2-3 weeks to help with initial acute pain. Taping can be a great way of testing to see if Orthotics will help with the issue as a more long term treatment solution.

Orthotics – Orthotics are shoe insoles that can be used to help support the arch of the foot and to help reduce the load on the planter fascia. They can be custom made specifically for your foot or they can be generic off the shelf insoles depending on the patient needs.

Footwear – A cushioned and supportive shoe is paramount to help healing of the planter fascia. Your Podiatrist will be able to guide you and recommend appropriate footwear for this issue.


Weight loss - Clinicians may provide education and counselling on exercise strategies to gain or maintain optimal lean body mass for individuals with heel pain/ plantar fasciitis. Clinicians may also refer individuals to an appropriate health care practitioner to address nutrition issues.


Extracorpeal Shockwave Therapy (ESWT) - involves the conversion of a sound wave into a shock wave that is applied repeatedly to a specific area of the body. In recent years the technique has become popular in the treatment of a number of recalcitrant musculoskeletal conditions including tennis elbow, Achilles tendinopathy, plantar fasciitis, and tendinitis of the shoulder. This treatment has been shown to be effective in Chronic planter heel pain (6 months duration) but hasn’t been proven to be effective in acute phases (4-6 weeks).


Conclusion

Planter heel pain (planter fasciitis) can be a very debilitating condition. It can be insidious in its onset and slowly worsens. This condition takes a lot of persistance and time to remedy but if the right diagnosis is made and an appropriate treatment plan is put in place then the outcome is normally positive one.

I hope this blog has helped you in some way. If you are experiencing heel pain or suspect that you may have plantar fasciitis, you should consult with an appropriately qualified Podiatrist. The sooner the better with this injury. Appointments can be made my calling/texting The Clare Podiatry Centre on (083)4393263 or by emailing Clarepodiatrycentre@gmail.com



Podiatrist

Aoife O’Gorman

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