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Heel pain is the most common biomechanical condition affecting the foot and ankle in middle-aged, physically active, overweight or pregnant individuals. The heel is the largest bone in the human foot and is subject to enormous pressure through patient weight gain, inappropriate footwear, increase in exercise or walking on hard surfaces.  Heel pain typically presents with pain in the heel (plantar fasciitis), behind the heel (Achilles tendinitis) or in the arch and involves an irritation of bones, muscles or ligaments. 

 

Growing children may also experience heel pain between the ages of 8-14 (Sever's disease) which is due to the open growth plate at the back of the heel and tight or slower developing muscles and tendons.

 

Plantar fasciitis, also known as 'heel spurs' or 'policemens foot', is a condition resulting in the overuse of the long band of tissue supporting the arch under the foot.  It often includes local inflammation with sharp pain or discomfort in the middle of the arch.  X-rays may reveal a bony growth or 'spur', however the spur rarely causes the pain and rarely is removed. 

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Causes – Plantar fasciitis results when the ligaments supporting the arch are repeatedly overused and small tears develop at the weakest point on the heel.  The most common causes are:

• An increase in weight

• Inappropriately fitting footwear or footwear that is worn out

• Repetitive activities involving a sudden increase, lots of ankle movement or rapid accelerative movements

• Prolonged standing, especially on hard surfaces

• Biomechanical factors affecting foot function such as flat feet, high arches, tight calf or hamstring muscles, or pathology affecting the big toe joint.

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Symptoms – The most common symptom is pain first thing in the morning or after periods of sitting that tends to 'ease' once warmed up.  The pain will often return the longer you are on  your feet and is exacerbated by activities such as stair climbing.  Many patients also find moving their ankle and toes towards the shin aggravates the condition.  As the condition progresses to a chronic nature, the pain is often present when standing and worsened with activity. 

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Diagnosis – Typically questions about signs and symptoms are asked and a biomechanical examination performed to assess function of the joints.  Occasionally an xray or ultrasound may be recommended. 

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Treatment – Treatment of plantar fasciitis is simple and effective in most cases.  Below is a selection of protocols typically recommended:

• Avoid aggravating activity, change running surface, reduce distance

• Strapping to reduce the stress on the plantar fasciia

• Anti-inflammatory medication and ice

• Stretching – particularly first thing in the morning, including toes and calves

• Orthotics to address the mechanical issues and prodide long term relief

• Change to footwear that is supportive and well-cushioned

• Avoid barefoot walking