Common heel pain condition symptoms and treatments are outlined below:
Plantar Heel Pain (click to open/close)
Often lumped under the term ‘plantar fasciitis’ or ‘heel spur’, plantar heel pain is very common and can be very disabling, especially those first few steps in the morning or when getting up from sitting. There are a number of differential diagnoses that need to be considered, for example calcaneal stress fracture, fat pad pathology, nerve irritation, abductor hallucis tendinopathy or plantar fascia pathology.
To help with diagnosis, we will conduct a thorough history, enabling us to:
- Consider whether further investigations are warranted (i.e. if any red flags are raised). These may include imaging to exclude fractures and tears, or blood tests for inflammatory markers.
- Determine causative factors – have you recently started a new training regime? Changed footwear? Had to lift or move heavy objects? Gained weight?
- Assess for underlying biomechanical factors that may be increasing both compression and tensile forces on the plantar fascia.
We have a wide range of therapies in our ‘tool box’, depending on your individual situation. These may include:
- Offloading in a moonboot if severe, or a fracture or tear is present
- Taping (neurophysiological effect) to reduce pain and improve function
- Stretching exercises – calf muscles and specific to the plantar fascia
- Strengthening exercises for the small muscles in the feet
- ESWT shockwave therapy
- Footwear advice
- Activity modification
- Dry needling and western medical acupuncture.
- Off-the-shelf or custom orthoses.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is a chronic injury caused by compression or squeezing of the nerve that provides sensation to the bottom of your foot. This nerve is called the Posterior Tibial Nerve and passes through a fibrous tunnel located behind the bone on the inside of your ankle, known as the Tarsal Tunnel.
This nerve is very sensitive to pressure once it becomes compressed or squeezed and can cause a variety of sensations or feelings. Often times, the feeling of “pins and needles”, burning or numbness may be felt. Pain may be felt when the area behind the inside ankle bone is pressed. The feeling of pain and numbness may also be felt when running or standing for long periods of time or even wearing tight shoes. These painful feelings or sensations are often worse at night.
In addition to pain directly over the nerve, patients often experience pain, tingling, burning or other unusual sensations through the arch, around to the bottom of the foot or radiating to the toes.
This condition may be diagnosed by a careful history and physical examination by your podiatrist. They may touch the course of the nerve with a vibrating tuning fork, or tap the nerve gently with a rubber percussion hammer.
Rest and over-the-counter anti-inflammatory medication, like ibuprofen, may help calm the inflamed nerve. Over-the-counter shoe inserts may also help control any excessive motion of your foot that is contributing to the injury. If the cause is abnormal motion of the foot, custom moulded orthotics may be provided. Avoiding certain types of shoes that may be too tight or too flimsy may also help.
Your GP may give you prescription strength anti-inflammatory medication or a cortisone injection to provide relief. If all conservative treatments fail, then surgery may be recommended to release the Posterior Tibial Nerve.
Sever’s disease (Calcaneal apophysitis) is common in younger adolescents. A child may complain of pain around the heel, particularly the back of the heel, and may limp.
Calcaneal apophysitis occurs when the growth plate in the heel has not yet fused. It is therefore common in children between around 10-14 years of age (but can occur earlier), particularly after a growth spurt. It is thought that the calf muscles may apply too much traction at the unfused growth plate causing swelling and pain. Flat or high arched feet may also increase risk.
Fortunately, symptoms will settle when the growth plate fuses, typically around 14 years of age, although this varies from person to person.
Treatment modalities such as supportive cushioned footwear, stretches, strapping, heel lifts or orthotics may help.