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Heel pain is the most common of all foot complaints. An estimated 400,000 people in Australia suffer from heel pain (Plantar Fasciitis). Heel spurs are also common, but they are merely a symptom and not the actual cause of heel pain. Pain at the back of the heel pain is called Achilles Tendonitis or Bursitis. Some children may suffer from pediatric heel pain or Sever's Disease. This page explains the symptoms and causes of heel pain and the treatment options available. If you have a fast internet connection you can also watch the video below.
"I wake up in the morning and feel a sharp, stabbing pain, right in the centre of my heel. After a while the pain subsides and comes back as a dull ache..."
Most people experience pain in the heel with their first steps in the morning, after getting out of bed. It is presented by a sharp stabbing pain at the bottom or front of the heel bone. The pain varies in severity. In most cases, heel pain is more severe following periods of inactivity (e.g. early in the morning or after sitting for a long period).
The pain will diminish throughout the day as the nerves and tissue adjust themselves and become accustomed to the inflamed area. However, after longer periods of inactivity (e.g. sitting at home or driving) heel pain will return stronger and sharper. It should be noted that many heel pain sufferers also experience tight calf muscles and tight Achilles Tendons (the ligament at the back of the heel).
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The most common cause of heel pain and heel spurs is a medical condition called Plantar Fasciitis. This is Latin for inflammation of Plantar Fascia. The Plantar Fascia is the flat band of fibrous tissue under the foot that connects your heel bone to your toes. It supports the arch of your foot. Normally, the fascia should be flexible and strong. However in many people this is not the case. Due to factors such as weight-gain, age and incorrect foot function (e.g. over-pronation) the plantar fascia are stretched out excessively with every step we take. Consequently the ligaments start to pull away from its weakest point: i.e. where the fascia inserts into the calcaneus (heel bone).
This constant tension leads to micro-tearing of the tissue and inflammation at the attachment of the plantar fascia and heel bone, causing heel pain. During rest (e.g. when you're asleep or sitting), the plantar fascia tightens and shortens. When getting up body weight is rapidly applied to the foot and the fascia must stretch and quickly lengthen, causing micro-tearing in the fascia. Hence, the stabbing pain with your first steps in the morning or after sitting.
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Because of the continuous pulling of the fascia at the heel bone, the body eventually responds by developing a bony growth on the heel bone. This is called a Heel Spur or Calcaneal spur. The spur itself doesn't cause any pain, it's merely a symptom. |
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Over-stretching of the Plantar Fascia is more likely to happen if:
- you suffer from over-pronation (lowering of the arch when the foot lands)
- you stand or walk on hard surfaces for long periods (e.g. because of your job)
- you have put on some weight in recent months/years or you are pregnant
- the muscles and tendons in your feet and legs are tight
- you are over 45
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Today various treatment solutions are available, some more effective than others.
Cortisone injections used to be the heel pain treatment most favoured by GP's. Cortisone is a powerful anti-inflammatory and when injected directly into the heel it will work almost immediately. However, many patients will have to come back for more injections as relief only lasts a few months, because this treatment method does not address the actual (biomechanical) cause of the inflammation. Because the injections can be quite painful, most GP's now will consider other less invasive treament options first.
ESWT (Extra Corporeal Shockwave Treatment) is more common in the USA than in Australia. During the treatment the specialist targets therapeutic shockwaves to the affected heel area.The treatment may take from 3 to 4 months to be fully effective. The doctor will schedule continued visits and post-ESWT continuance therapy. The shockwaves stimulate a healing response in the affected tissue and ligaments. The result is a reduction in inflammation and pain in the affected area. Some patients experience relief from the pain right away, but in others the full results from a single treatment may be experienced after a few months.
In very rare cases your doctor may suggest plantar fascia surgery as a last resort. In this cases the surgeon makes an incision into the ligaments, partially cutting the plantar fascia to release it. If a heel spur is present, the surgeon will remove it.
Fortunately there's a lot you can do yourself before seeking help from a specialist or GP and considering elaborate medical treatment. The self-treatment suggestions below are tried and tested over the years and if you follow them all, you have a good chance of finding relief, especially if your heel pain has come about quite recently (i.e. in the last 3 months).
Because the ligament around your heel bone is inflamed, you need to give the tissue a chance to recover. The body is very capable of healing itself and overcoming inflammation, provided you give it some rest. Therefore, avoid any running, sports, walking distance, walking up or down hills and standing for pro-longed periods for at least 6 weeks. All these activities do is aggravate the condition, giving your foot no chance of healing itself.
Minimise your walking to the necessary and completely avoid any barefoot walking, especially on hard tiles and floors. To keep your body fit try swimming or bike riding as a form of exercise. If you have gained weight in recent years or months, try to lose some.
Many people have tightness in their calf muscles and achilles tendons. Because these muscles work closely together with the plantar fascia under the foot, tightness in the back of the legs can hamper our natural walking pattern, placing strain on the plantar fascia. Flexible muscles are extremely important in the treatment and prevention of most foot and leg injuries. You can find a series of useful exercises here..
Twice or three times a day, apply an ice pack directly onto the heel and hold it for 5-10 minutes. This will help cool down the inflammation and provide temporary pain relief. Also, take anti-inflammatory drugs. Anti-inflammatory medications like Ibuprofen (found in Nurofen and Advil) will help decrease the inflammation that occurs in the fascia as a result of the tissue micro-tearing. Voltaren Rapid is also a strong anti-inflammatory drug and helpful for temporary pain relief.
Most GP's, podiatrists and physiotherapists recommend orthotic insoles to support the arches. The reason for this, is that orthotics help treat the cause of heel pain i.e. poor foot biomechanics. In most cases heel pain is simply caused by an incorrect walking pattern, which can be restored by wearing an orthotic arch support inside the shoes.
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Orthotics are corrective foot devices and they should not be confused with spongy, rubber footbeds or gel heel cups etc. Gel and rubber footbeds do cushion the heels and feet, but they do not provide any biomechanical correction. In fact, gel can do the opposite and make an incorrect walking pattern even more unstable.
Orthotic insoles support the arches and re-align the ankles and lower legs. Many of us have quite normal-looking arches when sitting or even standing. However, it is the impact of walking (and running) that has an effect on arches and ligaments in the foot. With every step we take the arches lower (a lot in some people, only a little in others) and this puts strain and tension on plantar fascia, which then leads to inflammation at the heel bone. Orthotics support the arches and release the excess tension on the plantar fascia, thereby allowing the inflamed tissue to heal.
To be effective for most people the orthotic doesn't have to be an expensive, custom-made device! A comprehensive Heel Pain study by the American Orthopaedic Foot and Ankle Society found that by wearing standard orthotics and doing a number of daily exercises, 95% of patients experienced substantial, lasting relief from their heel pain symptoms! Other Heel Pain studies have also shown the benefits of orthotics and exercises in the treatment of heel problems.
Developed by podiatrists, Footlogics orthotics support the arches and greatly reduce the tension on the Plantar Fascia, treating the cause of of heel problems. Plus, a shock-absorbing heel pad helps reduce the impact on the painful heel, providing added relief and walking comfort. Footlogics has helped many thousands of heel pain sufferers in Australia, New Zealand, the UK and Europe and our products are used and recommended by GP's, podiatrists and physiotherapists.
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Recommended orthotics for Heel Pain: Footlogics Casual or Footlogics Comfort |
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Footlogics orthotics are effective and affordable! You can buy Footlogics on-line from this website or by calling 1300 788 119. Delivery usually takes between 2-3 working days and postage and handling are FREE. Your purchase comes with a 100% Money-Back Guarantee. Footlogics products are also available from a number of selected retailers in NSW, Victoria, Queensland and Western Australia.
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Often children will complain of pain in one or both heels with running, sports or walking, usually at the back of the heel or under the heel. The cause of heel pain in children is a condition called calcaneal apophysitis, usually affecting 8 to 14-year olds. Heel pain is very common in children because of the very nature of their growing feet and legs. In children, the heel bone (the calcaneus) is not yet fully developed until the age of 14 or older. Until then, new bone is forming at the growth plate (the apophysis), a weak area located at the back of the heel. Repetitive stress on the growth plate (due to walking, running and sports) causes inflammation in the heel area. Because the heel's growth plate is sensitive to repeated running and pounding on hard surfaces, pediatric heel pain often reflects high activity. Children and adolescents involved in footy, soccer, running, or basketball are especially vulnerable.
Over-pronation (fallen arches and rolling inwards of the feet) will increase the stress on the the growth plate and is therefore a major contributing factor to heel pain in children.
Depending on the diagnosis and the severity of the pain, there a number of treatment options, including:
- Rest, reduce activity. yuor child should reduce or stop any activity that causes pain.
- Anti-inflammatory drugs, such as ibuprofen, help reduce pain and inflammation.
- Stretching exercises often help reduce the stress on the fascia - see above
- Orthotic insoles. Footlogics Children's Orthotics will help support the foot properly and prevent over-pronation
If pain persist, you should consult a Podiatrist or your GP.
A lesser known type of heel pain is a condition called Bursitis of the Heel. A bursa is a fluid-filled sac that cushions the muscles, tendons and bones in our joints. It helps keep them from rubbing against each other and reduces friction in the areas around the joints. Bursitis is Latin for inflammation of the bursa. Repeated movement and pressure on the bursa can cause it to swell and become inflamed. Trauma, infection or crystal deposits can also cause bursitis. The joints that are usually affected by bursitis are the large joints such as the shoulder, hip and knee but in some cases also the back of the heel.
People suffering from heel bursitis may experience pain and tenderness around the affected soft tissue, pain that worsens with movement or pressure, and visible swelling or skin redness in the area of the inflamed bursa at the back of the heel, which may restrict movement and affect your daily activities. Bursitis is in the heel area is also called Retrocalcaneal Bursitis or Calcaneal Bursitis. The calf comprises of two major muscle groups, both of which insert into the heel bone via the Achilles Tendons. Between the Achilles tendon and the heel bone lies a bursa known as the retrocalcaneal bursa. During contraction of the calf, tension is placed through the Achilles tendon and this rubs against the retrocalcaneal bursa. Treatment of Bursitis is similar to the above treatment options for normal heel pain, in particular ice, anti-inflammatories, exercises and orthotics can be beneficial for heel bursitis.
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In recent years a number of studies have been undertaken to measure the effectiveness of orthotic insoles in patients presenting with heel pain, heel spurs or Plantar Fasciitis. Below are short extracts from some of these studies...
Treatment of Plantar Fasciitis Using Standard “off the shelf “ Foot Orthoses.
Department of Podiatry, Curtin University, Kent Street, Bentley, Perth Western Australia .
Conclusions: Standard orthotics do have a significant effect on plantar fascia symptoms in this patient group. This finding supports the current literature. The results suggest that clinical measures of the foot have little or no value as predictors of the level of plantar fasciitis thickness, level of pain, disability or reduced activity seen in the patient. The navicular drop technique is a reliable foot posture evaluation. However, it would appear to have no correlation with any of the variables measured. Flatter feet do not seem to produce thicker plantar fascia, have more pain, cause greater disability or reduce activity. The only factor that seems to be correlated to plantar fascia thickness is the increase in BMI and patient's weight.
The American Orthopaedic Foot and Ankle Society (AOFAS) announced today the results of a two-year prospective randomized national study on the treatment of heel pain. The study found inexpensive off-the-shelf shoe inserts to be more effective than plastic custom arch supports in the initial treatment of heel pain (plantar fasciitis). Potentially, this finding could save more than $200 million in health care costs annually.
Heel pain affects over two million Americans annually and is the most common foot problem seen in medical practice. Non-operative care for heel pain provides satisfactory treatment for 90 percent of patients. However, research has not established which initial non-operative care is best. The current study, involving 15 orthopaedic foot and ankle centers, was designed to answer this question.
The investigation, conducted by the AOFAS Heel Pain Study Group, looked at the effectiveness of stretching exercises and orthotic devices in the treatment of heel pain. The researchers examined 236 patients who had no previous treatment for their heel pain and no serious medical problems.
The patients were divided (randomized prospectively) among five treatment groups. One group did only Achilles tendon and plantar fascia stretching exercises. (The plantar fascia is the band of tissue that stretches from the ball of the foot to the heel.) The other four groups used an off-the-shelf orthotic shoe insert along with the stretching exercises. All of the patients were examined by an orthopaedic foot and ankle specialist and asked to fill out an activity and symptom questionnaire. They returned after eight weeks of treatment for a repeat examination and questionnaire.
Seventy-two percent of those who did only Achilles tendon and plantar fascia stretching improved. Ninety-five percent of those who used orthotic insoles improved.
The study clearly demonstrates that a stretching program plus an inexpensive pharmacy-bought orthotic insole is the best and most cost effective treatment for heel pain," said Glenn Pfeffer, M.D., San Francisco, Chairman of the AOFAS Heel Pain Study Group. "These findings will allow patients and the health care system to save hundreds of millions of dollars each year by avoiding the unnecessary prescription of a rigid custom arch support for the initial treatment of heel pain."
Journal of Orthopaedic & Sports Physical Therapy, Official Publication of the Orthopaedic and Sports Physical Therapy Sections of the American Physical Therapy Association
The Impact of Foot Orthotics on Pain and Disability for Individuals suffering Plantar Fasciitis
CONCLUSION: Semirigid foot orthotics may significantly reduce pain experienced during walking, and may reduce more global measures of pain and disability for patients with chronic plantar fasciitis. Our results were obtained within a relatively short period of time for subjects who had experienced chronic symptoms associated with plantar fasciitis, and who had used multiple interventions before using the semirigid foot orthotics provided during the study. Semirigid foot orthotics similar to the ones used in this study may be a cost-effective intervention for plantar fasciitis considering the limited number of clinic visits required to fabricate and adjust the orthotics.
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