Heel Pain

With 26 bones, over 30 joints and around 100 tendons in each foot, there is a lot that can go wrong when this amazing system is overloaded or placed under pressure.

One of the most common results of the foot being strained beyond its normal parameters is heel pain. Heel pain can vary from a mild discomfort when you get out of bed in the morning, to a debilitating condition that hinders normal daily function.

What is heel pain?

Heel pain is often overlooked as a mild injury. However if left unchecked and untreated, this can develop into a chronic and debilitating pain that stops people from carrying out the most basic of daily tasks.

Mild heel pain can indicate the start of something bigger coming. This can be felt either during activities, such as walking, running or playing sports. This sort of mild heel pain can also be associated with certain shoes you may be wearing.

As a podiatrist, we see a lot of new heel pain cases as the weather warms up and people switch to open shoes, thongs and sandals. This is because this type of footwear, along with certain foot types creates a foot posture that places structures under stress, and results in pain and inflammation.

When someone experiences a sudden onset of heel pain, that is extremely debilitating, we expect to find either an acute tendon or ligament strain, a stress fracture within the heel bone itself, or an injury to the joints surrounding the heel bone. It is important you present quickly to your podiatrist for assessment and treatment.

It is important to point out that as Podiatrists, we have access to all imaging modalities that would enable us to properly diagnose your pain. This includes x-ray, ultrasound, MRI and CT scans.

Types of heel pain

Heel pain can come in many different forms:

Plantar Fasciitis

Pain on the bottom of your heel that feels like an aching, drawing sensation that only getting off your feet can help. This pain is more often associated with plantar fasciitis, also known as plantar heel pain. People with plantar fasciitis tend to report that the first few steps after getting out of bed in the morning are the worst.

Achilles Tendinopathy

Pain at the back of your heel that comes on during activity is generally associated with the Achilles tendon, or its insertion onto the heel bone. The Achilles tendon is the large tendon that connects your calf muscles to your foot. These muscles and tendon have an important role in propulsion through your gait cycle, and if overloaded can result in pain that is difficult to recover from without professional intervention. This sort of pain can also indicate a tear in the Achilles tendon that requires fast action by your podiatrist and allied healthcare team.

Calcaneal stress fracture

Pain that is felt as a deep ache within the heel, or along the sides of the heel can be associated with a stress fracture of the heel bone. Stress fractures are overuse injuries and may come on gradually with a sustained increase in activity. Seeking professional input to manage a stress fracture is important to prevent the bone from sustaining further damage and speeding up recovery.

Sever’s Disease

Heel pain in kids is very common in active children between the ages of 8-12 in girls and 8-15 in boys. There is a combination of factors that contribute to heel pain in children. Activity levels, rapid growth rates and certain foot types create the perfect storm for kids that fall into this category. This condition is known as Sever’s disease (or calcaneal apophysitis, which makes it easy to see why it’s called Sever’s…). This condition is related to the growth plate on the back of the heel bone that is still actively growing in children. Due to the factors above, the growth plate is placed under stress and becomes inflamed. This can stop children from playing sports or even playing games in the playground at school. It is very common and a podiatrist can help to get children back to normal fairly quickly.

It is important to seek a diagnosis from a podiatrist to establish what structures your heel pain is associated with. This will dictate the treatment pathways and bring you back to normal and pain free function as soon as possible.

Why do I wake up with heel pain in the morning?

By far and above the most common cause of heel pain is plantar fasciitis. The plantar fascia is thick band of tissue that fans out from the bottom of the heel to the balls of your feet. The plantar fascia helps to support the arches of the foot and plays an important role in propulsion during the gait cycle.

When your feet are overloaded by unusual activity, a change in activity types or levels, or a change in footwear, often the plantar fascia and its insertion on teh heel bone can become irritated. This sort of pain often presents as tenderness at the bottom of your heel, on those first few steps out of bed in the morning. Or a similar pain when you get on your feet after a rest from a busy day on your feet or after sport.

Podiatry for heel pain

Podiatrists have a huge arsenal for treating heel pain. Firstly, we are the foot experts and have out total focus on understanding the very complex mechanics and multiple structures of the foot. From a diagnostic perspective, we are in front of the game.

Treatment for heel pain is dependent on the condition we are treating. As you can see from the above information, there are many reasons why you may be experiencing heel pain, so a definitive diagnosis is important in planning the appropriate treatment plan that may include the following options or a combination of them:

• Orthotic therapy – custom-made foot orthosis that supports your feet and unloads structures that would otherwise be overloaded due to your mechanical makeup and foot posture.
• Footwear changes
• Taping techniques
• Manual therapy

Physio and Podiatry working together

At solutions Allied Health we recognise that different allied health professionals are specialists in certain areas of the body and treatments. A podiatrist treating heel pain can work closely with our physiotherapists to tap into what they do best, which is to treat the soft tissue elements of the condition you are suffering with. While the podiatrist creates a more efficient mechanical foundation with the use of orthotic therapy and footwear, our physiotherapists can help you build stronger resilience within the soft tissue structures under strain and prevent the injuries from re-occurring while rehabilitating your injury faster, by working alongside your podiatrist.

Our focus is getting you better, faster and for longer. We will use all the tools in our arsenal to achieve that for you as a team.