Heel pain affects a large number of patients who present to our Podiatrist here at SMI and it is estimated to affect between 11-15% of the population.
Pain can present first thing in the morning and ease up with activity. It is often worst after resting eg going from sitting to standing.
Anatomy – The plantar fascia is a thick ligament that attaches from the bottom of the heel and fans out across to the ball of the foot.
Pain can often be felt on palpation of the bottom of the heel or midportion of the bottom arch.
Subtle changes over time can result in flattening of the planta fascia. The ligament is a shock absorber and if stretched excessively it can become inflamed and painful.
A large portion that presents with heel pain can be due to plantar fasciopathy but not all.
Are formed by calcification of the plantar fascia and it’s attachment at the heel coming under increased strain over time. It is a progression of plantar fasciopathy. The pain is not from the spur itself but the inflammation of the plantar fascia so they do not require removal but rather off loading and pain management.
Baxter’s Nerve Compression
Running near the plantar fascia on the medial side the Tibial nerve of the foot diverges. The nerves can become entrapped in the capsule that runs medial and beneath the plantar fascia. This nerve entrapment is known as Baxter’s Nerve Entrapment can seen on it’s own or association with plantar fasciopathy.
Symptoms -This is also a common cause of heel pain and associated with plantar fasciitis. Pain may be radiating/burning/moving to the other side of the heel.
Plantar Fat Pad Syndrome
The plantar fat pad is made up of adipose tissue underneath the heel. Over time this fat padding can have degenerative changes resulting it’s thinning and a reduction in the protective cushioning on the structures of the heel. Ageing, obesity, gait changes, poor footwear, hard surfaces can all result in reduction of the plantar fat pad and pain due to loss of elasticity.
With loss of fat padding the tissue can become inflamed and even prone to bruising of the heel bone. You can feel the pain directly under the heel when it is palpated.
The Achilles tendon inserts just behind the heel. Changes here can also result in calcification and spurring of the tendon. Often patients will confuse the spurs with spurs associated with plantar fasciopathy. The two can certainly be linked but if uncertain see your Podiatrist for further assessment.
Achilles tendinopathy can affect the midportion of the tendon also, It can become chronically inflamed and take to time settle. Your Podiatrist can help plan to off load, strengthen, and reduce the pain from the aggravated tendon.
Severs Disease (Calcaneal Apophysitis)
Most commonly occurs in adolescents aged between 8-15 years and more frequently in boys. The growth plate of the heel bone is open in children and not yet joined like an adults, a tight Achilles tendon can cause aggravation at the growth plate in the heel. It is believed that Severs can be related to mechanical problems with the way the foot functions as well as rapid growth and sporting activities such as football, soccer and netball that can overload the Achilles.
Often sports shoes can aggravate the condition.
SMI Podiatrists are experts in diagnosing the cause of your heel pain. This is important as it may be a different mechanism or structure to what you initially thought, and this may change the way it is treated.
Once our Podiatrist has determined the cause of your heel pain, they will create a plan with you to help you return to being pain free and reach your goals.
This may include pain management ice, heat, activity modification, pain medications, topical anti-inflammatories, laser treatments, dry needling or injection therapies when required.
Off loading the region with shoes, padding, strapping inserts, orthotics is one of the most important treatments that can be implemented.
Return to function may include stretching, strengthening and massage techniques.
Book an appointment at Sports Medicine Institute to correctly determine the cause of your heel pain and develop a plan to get you back to being pain free today.