Heel Pain

Overview

The heel is the largest bone in the human foot, and acts as a firm support for the weight of the body. Heel pain is easily the most common problem impacting the foot and ankle. People typically strain their heels through pounding their feet on hard surfaces, becoming overweight or wearing unsuitable shoes. The pain experienced can range from mild to disabling.

This particular foot condition typically involves an irritation of either the heel’s bones, muscles or tendons. The most common causes of heel pain involve irritation under the heel (Plantar Fasciitis) or just behind it (Achilles Tendinitis), where the Achilles tendon connects to the heel bone.

Sever’s Disease is another common form of heel pain in growing children, where a child’s growth plate (an area at the end of a developing bone) grows faster than the muscles, tendons and ligaments in their leg.

Heel pain can correct itself over time. However, it is recommended you consult with a podiatrist to diagnose the underlying source of your heel pain and ensure the discomfort does not become persistent and chronic in nature.

Heel pain is most common in people who are middle-aged, physically active, on their feet for long periods, overweight or pregnant. Children aged between eight and 13, particularly boys, are also susceptible to pain of the heel.

You can find more information about the most common forms of heel pain below.

Plantar Fasciitis

Plantar Fasciitis

Overview

Plantar Fasciitis, also known as ‘heel spurs’ or ‘jogger’s heel’, is a disorder resulting in heel pain. It involves the overuse of the plantar fascia, the thick band of tissue running from the heel bone to the ball of the foot that supports the arch of the foot and acts as a shock absorber. A third of people will experience the condition in both legs, and it is most common in middle-aged adults.

Causes

Plantar Fasciitis is caused when the ligaments supporting the arch of the foot are repeatedly strained. Typically the planter fascia will stretch excessively and develop small tears where it attaches to the heel that causes the foot pain when standing or walking.

The most common causes of the condition are:

  • Factors affecting how the feet work such as abnormal inward twisting or rolling of the foot, high arches, flat feet, tight calf muscles or tight tendons at the back of the heel.
  • Repetitive activities that require long walks or excessive periods of standing on hard or different surfaces, or running.
  • Being overweight.
  • Shoes that don’t fit properly, are worn out or lack the required support needed.
  • The ageing process.

Symptoms

People experiencing Plantar Fasciitis will typically feel heel pain after standing or walking for long periods, with the discomfort usually lessening after taking several steps. Pain is often experienced in the front and bottom of the heel, and can feel like a throb, burn or ache.

Pain will often be at its worst the longer you are on your feet, and can be exacerbated by certain movements such as climbing stairs or standing on your toes. It is also often at its most severe with the first steps of the day or following a period of sitting. Discomfort for people experiencing Plantar Fasciitis is often triggered by bending the foot and toes towards the shin and can be aggravated by a tight Achilles tendon.

The disorder is often characterised by pain felt at the beginning of exercise that improves as exercise continues but returns after it is completed.

Diagnosis

To establish whether a person’s pain is caused by Plantar Fasciitis, a podiatrist would ask you questions about your symptoms and past health, perform a Biomechanical Assessment to study your range of movement, and may also recommend a foot X-ray and/or an ultrasound scan.

Treatment

Around 90 per cent of Plantar Fasciitis cases resolve themselves in six months to a year when treated correctly. Below is a selection of the methods Dan Everson Podiatry would typically recommend, alone or in combination, for patients experiencing Plantar Fasciitis:

  • Rest your feet. Limit or stop activities aggravating your heel pain. Refraining from running or walking on hard surfaces is essential.
  • Apply ice to the affected area to reduce inflammation.
  • Use pain-relief medication.
  • Stretch in the morning or during the day – toe stretches, calf stretches and towel stretches are particularly helpful.
  • Invest in shoes that have great support for the feet’s arches and cushion the heel. Look for athletic shoes or shoes with a well-cushioned sole.
  • Orthotics may be prescribed to help treat this condition and prevent a recurrence. Dan Everson recommends its range of Kinetic Orthotics, which is designed using patent-protected technology that optimises the way force is transferred as you move.
  • Put on your shoes as soon as you get out of bed, and avoid walking barefoot or in slippers.
  • Night splints to stretch your foot and lower leg at night.

Prevention

Dan Everson Podiatry would recommend the following activities to help prevent Plantar Fasciitis.

  • Regularly relax your lower legs during periods when you are walking, running, sitting or standing, particularly your calves and ankles. Tension held anywhere in the legs and glutes can help trigger this condition.
  • Avoid pulling yourself forward with your legs when moving. Let your upper body lead and legs follow.
  • Always land evenly on the middle of your foot when walking or running instead of striking heavily with the heel.
  • Never walk barefoot on hard surfaces such as concrete or tiles.
  • Walk and run on flat surfaces as much as possible.
  • Stretch your feet and calves regularly.
  • Enjoy regular foot massages.
Achilles Tendinopathy

Achilles Tendinopathy

Overview

The Achilles tendon is the thickest tendon in the body and connects the calf muscles to the heel bones. It allows you to push your body up when walking or running. Achilles Tendinopathy is a condition that causes pain, swelling, stiffness and reduced strength of the Achilles tendon.

This damage can occur over time or may happen suddenly due to a high force going through the tendon beyond what it can withstand. In some cases the tendon can rupture completely. Six in every 100 people will experience this condition at some stage of their lives, although it is most common in young people and athletes.

Causes

This condition is a result of the overuse of muscles that can lead to inflammation and microtears of the Achilles tendon. Over time, scar tissue can develop on the tendon that contributes to pain and stiffness.

The most common causes of this condition are:

  • Engaging in sports that require strenuous stop and start motions.
  • Running on uneven surfaces.
  • A sudden or dramatic increase in the intensity of physical exercise or activity.
  • Little or no warm up before exercise.
  • Abnormal foot mechanics.
  • Wearing shoes with poor heel or arch support.

Symptoms

A person with Achilles Tendinopathy may experience a burning pain in the affected area at the beginning of exercise that improves as exercise continues then returns afterwards. This is most common with runners.

A tender, red and inflamed lump may be present on the tendon and it may feel especially stiff and weak in the morning and during the night. Severe pain that comes on suddenly and causes difficulty walking may indicate a severe case of Achilles Tendinopathy, potentially involving a complete rupture of the Achilles Tendon.

Diagnosis

To determine if a patient’s pain is caused by Achilles Tendinopathy, a podiatrist would typically ask questions about your symptoms and health history. The patient may be asked to stand and hop on one foot or to raise their heel off the ground to fully assess the capability and range of motion of the lower limbs. These observations will provide clues about possible damage to the tendon. In some cases it may be necessary to conduct an MRI or Ultrasound to understand the severity of the injury.

Treatment

If treated correctly, Achilles Tendinopathy should not have any long-term effects. Below is a selection of the methods Dan Everson Podiatry would typically recommend, alone or in combination, for patients suffering from this condition:

  • Rest your feet, although too much rest can slow recovery time.
  • Strap the affected area after seeking professional advice.
  • Apply ice to the affected area to reduce inflammation.
  • Use pain-relief medication.
  • Avoiding high impact activities.
  • Slowly return to physical activity or exercise routines as pain permits.
  • Perform Achilles tendon exercises after consulting with your podiatrist.
  • Invest in shoes that have great support for the feet’s arches and cushion the heel. Look for athletic shoes or ones with a well-cushioned sole.
  • Orthotics may be prescribed to help treat this condition and prevent a recurrence. Dan Everson recommends its range of Kinetic Orthotics, which is designed using patent-protected technology that optimises the way force is transferred as you move.
  • Night splints to stretch your feet at night.

Prevention

Dan Everson Podiatry would recommend the following activities to help prevent Achilles Tendinopathy:

  • When increasing your exercise and activity levels, do so gradually.
  • Walk and run on flat surfaces as much as possible.
  • Warm up – exercise at a slower pace and perform dynamic and static stretching before exercise.
  • Seek advice from a podiatrist on the most appropriate footwear or footwear modifications for your needs.
  • Strengthen your calf muscles with bodyweight and resistance training.
  • Stretch your feet and calves regularly.
  • Enjoy regular foot massages.
Sever's Disease

Sever’s Disease

Overview

Sever’s Disease is a very common heel injury among children and growing adolescents. It is a disorder of the bone and, whilst it can be quite painful, the condition is mostly temporary and has no known long-term effects.

Causes

Sever’s Disease occurs when the growth plate of the heel starts to swell as a result of the heel bones growing faster than the muscles and tendons, causing them to tighten and overstretch. This in turn makes the heel less flexible and puts pressure on the heel’s growth plate. It then becomes damaged and swollen, tender and causes pain in and around the affected heel.

The most common causes of this condition are:

  • Excessive running and jumping – especially when performed on hard surfaces like concrete.
  • Prolonged standing.
  • Inward rolling feet while standing, walking or running.
  • Flat feet or “fallen arches”
  • Too much pressure on the heels as a result of being overweight.
  • Short leg syndrome.

Symptoms

The most obvious and common symptom of Sever’s Disease is pain in and around the heel, specifically the back of the heel.

Swelling and redness of the heel may also be visible and a person may experience heel pain during physical activities or exercise, particularly those involving running or jumping. Pain may increase after physical activity.

Children with this condition may have difficulty walking and also experience pain when the heel is squeezed.

Diagnosis

Dan Everson Podiatry can diagnose a case of Sever’s Disease through history taking, a physical examination of the foot and a Biomechanical Assessment to study your range of movement. It is likely your podiatrist may also squeeze the back and side of the heels and ask you to walk on your tiptoes to assess pain levels. More extensive tests for other causes may be required if the pain is persistent or continues during rest.

Other symptoms requiring careful examination include pain that disrupts sleep or significant swelling of the heel. An X-ray, ultrasound or MRI can be used to exclude the possibility of a more serious problem.

Treatment

Sever’s Disease will improve on its own when the foot is rested and the bones in the heel area have stopped growing. There is no known long-term disability resulting from the condition, and symptoms would be expected to subside within a two to eight week period with the correct treatment. It is still recommended people who suspect they may have this condition consult with their podiatrist for assessment and treatment. Below is a selection of the methods Dan Everson Podiatry would typically recommend, alone or in combination, to treat Sever’s Disease and prevent a recurrence:

  • Minimise, and if possible totally avoid, any activity that causes pain in the heels until you have completely recovered.
  • Apply ice to the affected area to reduce inflammation.
  • Use pain-relief medication.
  • Perform regular exercises for the feet and legs to stretch the muscles and tendons.
  • Invest in shoes that have great support for the feet’s arches and cushion the heel. Look for athletic shoes or ones with a well-cushioned sole.
  • To cure the condition and stop recurrences, Kinetic Orthotics can be prescribed to correct abnormal joint motion in the feet. This is a range recommended by Dan Everson Podiatry, and is designed using patent-protected technology that optimises the way force is transferred as you move.

Prevention

Dan Everson Podiatry recommends the following activities to help prevent Sever’s Disease:

  • Seek advice from your podiatrist on the most appropriate footwear or footwear modifications for your needs.
  • Avoid excessive running and jumping on hard surfaces.
  • Encourage greater flexibility with appropriate leg and foot exercises.
  • If a person is overweight, weight loss may be advised to decrease pressure on the heel.