Podiatry insights - Heel Pain

As a podiatrist, I see patients who present with a range of biomechanical problems and concerns however by far the most commonly occurring complaint people have is heel pain. Whenever there is any pain in the body, it is your bodies way of informing you that something potentially malicious is occurring that may require treatment of attention. Heel pain may be caused by a number of factors and as such can be treated in any number of way. This weeks blog will aim to bring some light to this common problem and how it can be corrected.
What are some causes of heel pain?
The heel is collectively a complicated structure which consists of:

• A bone called the calcaneus.
• A layer of soft fatty material that acts like an anchor and shock absorber.
• A series of ligaments connecting the heel to the ankle.
• A number of tendons of muscles both found inside and outside the foot that insert into different parts of the heel enabling different movements and functions.

Often times, heel pain is a result of excessive strain placed upon these soft tissues in the foot. During every day activities such as walking and running, the heel structure collectively experiences a large quantity of forces throughout its components. This can lead to tearing, straining of soft tissues or bruising and fracture of bones. The list outlined detailed below is a non exhaustive outline of commonly observed factors that may be contributing to your heel pain.

1. Plantar Fasciitis
   1. Put simply, is an inflammation of the plantar fascia (a band of fibrous tissue that supports the arch and connects the heel to the toes). By far the most common cause of heel pain, it is commonly caused by excessively flat or high arched feet, overly active lifestyles and poor choices in footwear.
2. Flat feet (pronated) or feet that roll out (supinate) excessively
   1. It is normal for feet to roll in and out a certain amount during activities of everyday living.  Both motions are essential in the proper functioning of the foot structure. Excessive motions (either rolling in or out) however, does put certain soft tissues in the feet under stress. The intrinsic (found inside) muscles of the feet have to work extra hard to cope with feet that are already in the extreme positional alignment that they eventually become injured and sore. The clearest example of this is the effect that flatter or high arch feet have on the plantar fascia. Feet that exhibit these two extremes (more commonly in flat feet), lead to long term stress across the fascia and particularly at the heel section which can lead to heel pain and may precipitate plantar fasciitis (mentioned above).
3. Bursitis
   1. The heel has a number of fluid filled sacs called ‘bursae’ which can become inflamed as a result of compressive pressure during weight bearing activities or injury. Much like plantar fasciitis, it is this inflammation that is the primary cause of discomfort.
4. Neuroma or cysts
   1. Since we are dealing with soft tissue structures in the foot, they require both blood supply and nerve supply. Following injury or by chance, cysts may form either in the bone or within the soft tissue that may ilicit pain on weight bearing. Neuromas form when the healing process results in an excessive collection of nerve fibres forming a bundle which may lead to radiating pain when the lump is pressed.
5. Bone bruises or fractures
   1. Often seen in response to traumatic injury or long term overuse of the heel structures, bruising and fracture of bone will often result in the decreased integrity of the bone surface and result in heel pain that does not alleviate over time and may actually get worse the longer you spend time on your feet.
6. Muscular, tendon or ligament fatigue
   1. Certain foot types and lifestyle factors over the course of a lifetime will put overly large amount of stress on the foot structures. Normally this may not be a problem, however over the long term, they may suffer from fatigue and result in dull, aching pain developing in the region of the heel.
7. Tight calf muscles
   1. It might seem trivial, but tight calf muscles can lead to discomfort in the heel. The calf muscles insert into the back of the heel through the Achilles tendon. When the calf muscle complex is overly tight, the strong Achilles tendon will continue to pull on the bone attachment point. This can in turn lead to inflammation and pain at the site where the bone and tendon meet (insertion point). Similarly to this, calf muscle tightness can lead to inflammation and stress of the middle section of the Achilles tendon (mid-portion) which can also lead to residual heel pain.

It is not all doom and gloom however. There are a number of things that factored in to help reduce symptoms of current heel pain or reduce your chances of developing it initially. Some of these include:

• Apply ice to sore areas of the heel daily for about 10 minutes. Using a frozen bottle of water as a roller is an effective way at not only icing the affected area, but also to stretch out constricted structures.
• Stretch your calves. This can be done simply using a towel or a belt and involves pulling the ball of the foot up towards you. Hold for 30 seconds, and repeat 3 times. Perform this daily. DON’T forget to stretch before and after exercise.
• Avoid inappropriate footwear. Always try to wear foot supportive shoes and avoid walking around barefoot on hard surfaces. Shoes with supportive heel counters work well to cushion the pressure going through the heel and reducing heel pain.
• Seek professional help and guidance. Heel pain is relatively easy to treat once the causing factors are identified. If you have lingering pain, seek the help of a podiatrist who can not only give you a definitive diagnosis but also structure a personalised treatment plan .

If you of anyone you love is suffering from heel pain,  we are here to help. Call us at Health Associates and let us help rid you of your heel pain and get you back on your feet happy and healthy.

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Dr Anel Kapur delivers an outstanding clinical podiatric care to all clients. He has earnt himself an exceptional reputation among his clients for his attention to detail, gentle approach and depth of knowledge.
Dr Anel Kapur is available for appointments Monday and Saturday.
Bookings are available online or contact reception on 9542 3330 ​