Heel Pain

The heel is a designed to absorb impact of body weight during walking and running, and if pain develops it can be very disabling.

Heel pain is a common foot complaint for which there can be many causes such as plantar fasciitis (fasciois), achilles tendinopathy, heel fracture, severs disease, bursitis or arthritis. Seeing a podiatrist can help with diagnosis, treatment and prevention advice.

First line self-care can help:

• simple painkillers or non-steroidals such as ibuprofen
• application of ice packs
• gentle stretching exercises
• wearing heel pads
• wearing shoes with a heel of 2-3cm
• avoiding standing/walking for long periods
• not walking barefoot or in flat shoes

If there is no improvement or the pain gets worse then you should see a GP or podiatrist for assessment

 

Plantar Fasciitis (or Fasciosis)

This is the most common cause of heel pain affecting around 1 in 10 people, usually between the ages of 40-60 years and is twice as common in women.  It usually gets better with time but different treatments may help recovery.

Plantar fasciitis is usually caused by overuse, injury or biomechanical abnormalities resulting in micro tears and possible inflammation of the plantar fascia which is a strong band of tissue that stretches from your heel bone (calcaneum) to base of the toes.

The plantar fascia helps to support the arch of the foot and also acts as a shock absorber.

What Are The Symptoms?

The main symptom is pain which can be felt anywhere on the underside of your heel, but most commonly about 4cm forward of the heel bone is generally the main source of pain.

 

 

Pain is often described as a stabbing or aching pain and is often worse in the morning or getting up after periods of rest (non-weight bearing). It can also be made worse with periods of long standing, walking barefoot on hard surfaces or with sudden stretching of the sole such as when walking up the stairs or standing on tiptoes.  You may find yourself limping.

 

What Can Be Done To Help Painful Plantar Fasciitis?

Firstly, a tincture of time!

There is some solace in the fact that plantar fasciitis is self-limiting which means it usually does heal by itself.  However this can be over many months, during which time pain can limit activity and life enjoyment.

The following interventions may help symptoms and speed up recovery:

REST	Don’t do excessive activity, long periods on your feet or sudden stretching of your sole.
FOOTWEAR	Wear well supportive shoes that have a slight heel, good cushioning and arch supports. A trainer type shoe is ideal. Avoid walking barefoot on hard surfaces. Plantar fasciitis is often precipitated after a period of wearing flip flop or ballerina pump type shoes.
HEEL PADS & ARCH SUPPORTS	These can be bought and placed inside both shoes and work best if worn at all times.
PAIN RELIEF	You can try placing ice packs on the painful area for periods of 10-15 minutes several times a day. You can also try taking paracetamol and/or anti-inflammatories such as ibuprofen (no more than the advised daily amount). An anti-inflammatory gel rubbed directly on to the painful area may also help.
EXERCISES	Exercises that aim to gently stretch and strengthen the foot and calf muscles can be undertaken. See Exercises for Plantar Fasciitis (PDF 102KB) and the YouTube videos below:
STEROID INJECTION	Cortisone injections can be tried if the pain is really bad or conservative methods have not worked. These may help to reduce inflammation and pain in some people but more than one injection over a period of time may be required.
EXTRACORPOREAL SHOCK WAVE THERAPY	This involves delivery of high energy sound waves to the painful area which may stimulate healing. The potential risks and benefits should be discussed with your GP or podiatrist.
AUTOLOGOUS BLOOD INJECTION	A 2-3mls sample of your blood is taken and then injected into the area around the affected tissue. Sometimes the blood sample is separated first to produce platelet rich plasma (PRP) before this is injected. The aim is to supply the connective tissue with growth factors that promote the healing process. NICE have reported no safety concerns, but report more evidence is required to determine efficacy and this method may be considered if the symptoms of plantar fasciitis are not resolving with other methods. Find out more about autologous blood injection for plantar fasciitis on the National Institute for Health & Care Excellence website.
SURGERY	Usually considered as a last resort if the pain has not improved with conservative treatments after about 12 months. A plantar fascia release may be considered but this is not always successful and does have risk of several complications so would need to be carefully considered and discussed with a podiatric surgeon. Your GP would need to refer you or you can pay to see them privately.