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What Causes Heel Pain?

What Causes Heel Pain?

Plantar fasciitis is a common cause of heel pain. It usually involves pain at the plantar fascia where it attaches to the heel bone (1). This fascia naturally stretches during standing and walking. The fascia can only stretch so far, but if the tension continues to increase within the fascia, it stiffens. (3) Under normal circumstances, the plantar fascia acts like a shock absorber for your foot, but, if the tension on the plantar fascia exceeds the limits of the tissue, small tears can develop in the fascia (1). Repetitive load and tension can cause the fascia to become stiff, inflamed and painful.

Risk factors for plantar fasciitis include:

  • Older age (between the ages of 40-60)
  • Female
  • Undertaking certain activities that place a higher stress on the heel (dancing, running, high impact activities)
  • Obesity
  • Occupations with prolonged standing (nurses, teacher, wait staff etc)
  • Improper footwear (flat, thin, hard soles, high heels, no support)

Plantar Fasciitis is generally described as severe “first step” pain in the morning or after a prolonged period of rest. This pain usually improves after “warming up” within a short period of walking, but may worsen after a period of increased activity (e.g. sport or going for a long walk). Pain may also flare up after a day of activity. Upon sitting of an evening, the pain may increase. This after-rest evening pain is thought to be due to the swelling in the area of pain compressing the nerve endings in the area of pain when you are on your feet. (2)

Other Symptoms:

  • Local tenderness- pain through the heel and the inside of the arch
  • No swelling- only in very severe cases will there be swelling in the area
  • Nodular Changes: bumps and lumps may form within the arch area
  • Pain with range of movement: Dorsiflexing the big toe (pointing it up towards your body) often causes pain through the arch

 

BUT I HAVE BONE SPURS, NOT PLANTAR FASCIITIS!

Often, a patient will report that imaging has shown bone spurs underlying their heels. Bony spurs are frequently associated with plantar heel pain, but they are not generally the cause of the pain. Heel spurs are commonly present in the population with no heel pain.

There are some occasions in which a heel spur is the cause of the pain – a fracture in a heel spur, or fat pad atrophy (thinning of the fat pad in the heel) that may cause symptoms within the heel spur, but the attachment of the plantar fascia to the heel bone is the likely cause of heel pain.

 

TREATMENT:

  • Rest/Activity Modification: This is most important in the treatment of plantar fasciitis to allow reduction of tension to occur through the fascia
  • Stretching: Specific stretching should be to the gastrocnemius/soleus complex (calf), the hamstrings and the plantar fascia itself. Studies have shown that stretching remains the cornerstone in treatment of plantar fasciitis (5)
  • Strengthening the plantar fascia: The plantar fascia cannot maintain its arch structure alone and heavily relies on soft tissue surrounding it to maintain its position (4). Strengthening the structures that surround the fascia is therefore super important to maintain the integrity and structure of your arch
  • Footwear changes: it is important to assess all footwear and change accordingly if it is found the shoes worn are not providing adequate cushioning or support.
  • Taping: Taping can be used to predict the success of orthotic therapy. Taping provides short-term relief to biomechanical factors that may be indicative of plantar fasciitis (5). Among other things, taping helps to reinforce the plantar fascia and provide compression over the site of the pain.
  • Orthotics: orthotics are used as a part of a treatment program that also incorporates conservative treatment. If your biomechanics are contributing to increased tension in your plantar fascia, orthotics can help to reduce this tension
  • Dry Needling: dry needling is used in conjunction with conservative therapies to reduce tension within trigger points in the foot
  • Shockwave Therapy: Shockwave Therapy is used for the management of soft tissue and tendon injuries

If you are struggling with sore heels, Darwin Podiatry is here to help. Call 89419955 to make an appointment with our experienced Podiatrists for assessment today.

REFERENCES:

  1. Risk Factors for Plantar Fasciitis Among Assembly Plant Workers Robert A. Werner, MD MS, Nancy Gell, MPH PT, Anne Hartigan, MD, Neal Wiggerman, MS, William M. Keyserling, PhD
  2. Auleciems, L.M., 1995. Myofascial pain syndrome: a multidisciplinary approach. Nurse Practitioner 20 (4), 18–28. Bartold, S.J., 1997. Conservative management of plantar fasciitis. Sport Health 10 (3), 17–28.\
  3. Perry, J., 1983. Anatomy and biomechanics of the hindfoot. Clinical Orthopaedics 177, 9–15.
  4. Bartold, S., 2003. The plantar fascia as a source of pain- biomechanics, presentation and treatment. Journal of Bodywork and Movement Therapies (2004) 8, 214–226
  5. Pfeffer, G.B., 1997. The conservative management of plantar fasciitis: a prospective randomised multicentre outcome study. Presented at the 27th Annual Meeting of the AOFAS, February 16th 1997 San Francisco, CA.

 

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