The heel bone (calcaneus) is the largest of the 26 bones that form your foot. Attached above to the talus and in front to the navicular and cuboid bones, this bone acts as a rigid anchor while we walk or run. The heel takes on almost 1.25 times our body weight while walking and more than double of this while running. Multiply this by 7000 steps (because that’s how much we walk daily!) the result is, a possible pain in the heel.
Plantar fasciitis and achilles tendonitis are the top causes of heel pain. Usually, the heel pain is dull and is worse when weight-bearing. Rest helps to relieve the pain and discomfort in the majority of the cases. At times the pain can be severe causing intense pain when weight-bearing.
Main Causes of heel pain:
- Plantar Fasciitis – refers to overload of the plantar fascia. Plantar fascia is a tough band of soft tissue extending from the front of the heel to the toes. It can be likened to a trampoline mat as it provides support and spring to the bones of the foot while walking or running. Plantar fasciitis is an overuse injury occurring due to repeated stresses while walking and running. This condition is more common in jumpers, runners and dancers.The patient complains of pain and tenderness under the heel and on the inner side of the sole of the foot. Shooting pain in the heel when one attempts to walk in the morning, is the characteristic feature of plantar fasciitis. During the night, the fascia shortens as the feet are relaxed. So in the morning, when the heel is placed on the floor, the fascia is stretched suddenly which can induce significant pain. Frequently, this pain will ease when the patient is on their feet for 5-30 minutes.Certain factors such as pronated feet, a high medial arch, tight calf muscles and excessive weight may act as predisposing factors for plantar fasciitis. Deep soft tissue work of the plantar fascia along with stretching of the calf muscle is effective in relieving pain. Wearing comfortable footwear can assist can help to decrease the pain intensity somewhat.
- Achilles tendonitis: The achilles tendon is a thick cord extending from the calf muscle to the back of the heel. Achilles tendonitis is common among runners. The athlete complains of pain behind the heel and reduced ankle movements. As the tendon also undergoes degeneration with age, elderly athletes are more prone to this condition. Incorrect training techniques (too much too soon), running uphill, tight calf muscle and flat foot increase the risk of developing achilles tendonitis. Early identification of this injury is important for faster recovery.Calf stretching and strengthening form the mainstay of the treatment of achilles tendonitis. Eccentric strengthening of the calf aids in early recovery.
- Bruised Heel: It is commonly known as Policeman’s heel and is an overuse injury of the soft tissues present under the heel, particularly the fat pad. Typically seen in runners or soldiers, this condition occurs due to repeated pounding of the heel as in long distance running, or landing from height. The condition is quite often confused with plantar fasciitis. But there are subtle differences between the two. The pain in a bruised heel is located at the centre or slightly outer side of the heel as opposed to plantar fasciitis where the pain is more on the inner side of the heel.Protective taping and use of heel cups or silicone gel heel pads help to relieve the pain. It is also advisable to wear shoes with heals, instead of flat soles.
- Retrocalcaneal bursitis: Runners are commonly afflicted with this condition. When it occurs together with achilles tendonitis. The patient complains of pain at the back of the heel, especially when running uphill or on soft surfaces. There is swelling and tenderness behind the heel which makes it painful to wear shoes.The condition is usually managed by protective taping using donut shaped pad. As pronation of the foot can predispose to retrocalcaneal bursitis, insoles to correct pronation and stretching of calf muscles also help to relieve the discomfort.
- Stress fracture of Calcaneus: Stress fracture of the calcaneus is an overuse injury due to repeated heel strike as seen in runners. The hairline fracture causes intense pain during running or jumping. The symptoms resemble that of a bruised heel. It can be diagnosed by squeezing the heel between his thumb and finger. The treatment of calcaneal stress fracture involves 6-8 weeks of compulsory rest followed by a gradual return to training.
- Sever’s Disease: Sever’s disease is usually seen in children showing sudden growth spurt. Thus it is a common cause of heel pain in kids between 7-14 years of age. This is also an overuse injury. The young athletes complain of pain and tenderness at the back of the heel that increases with activity. This is accompanied by tightness of calf muscle and reduced ankle movement.Although young athletes generally outgrow this condition, rest, non-weight bearing activities, and reduction in training intensity are advisable during this phase. Weight bearing and high impact activities must be avoided.
- Heel Spur: It’s a heel with a spike. The bony extension occurs at the base of the calcaneus and may be seen in patients with plantar fasciitis. The patient complains of severe pain under the heel especially during walking.Treatment involves plantar fascia stretching and correction of foot biomechanics. Shoes with soft heel are often recommended. Flat soles should be avoided.
- Tarsal Tunnel Syndrome: This is actually a midfoot condition that can cause heel pain. Compression of the posterior tibial nerve in the groove behind the medial malleolus (bone on inside of ankle) causes pain and burning sensation under the heel. The sensation may extend to the toes. Patients may also complain of pins and needles sensation in their soles that worsens on walking or at night. A positive tinel’s test helps to differentiate tarsal tunnel syndrome from plantar fasciitis.
Treatment of tarsal tunnel syndrome includes rest, followed by an intensive rehabilitation program involving lower limb stretching and strengthening.
Risk factors for heel pain
- Increased body weight (body Mass Index>30)
- Incorrect foot wear (flat soles or high heels)
- Standing for a long time
- Tight leg and foot muscles
Interestingly, research suggests that foot posture is not a major determining factor in heel pain. Many patients will attend the clinic concerned about their “fallen arches” and attribute their heel pain to this; however, the research does not support this theory.
Heel Pain Treatment at Naas Physiotherapy Clinic
At The Physio Clinic, Naas we are highly experienced in treating foot pain. We believe that curing chronic heel pain depends on obtaining the right diagnosis. Wee also focus on techniques that prevent injury and minimise recurrence. The following treatment options are available at the Naas physiotherapy clinic
- Complete biomechanical analysis
- Gait analysis
- Running analysis
- Correction of muscle strength imbalance
- Footwear assessment and correction
- Sports specific stretching
- Sports specific strengthening
- Eccentric loading exercises
- Plyometric training
- Agility and flexibility training
- Balance and proprioceptive exercises
- Analysis of training and correction of overtraining
- Sports specific drills
- Sports massage and myofascial release
- Post-operative rehabilitation after corrective foot surgery
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To find out more, contact Naas Physio Clinic Naas on:
(045) 874 682
or email us at email@example.com
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