Heel Pain Treatment

Plantar fasciitis (Heel Spur Syndrome)

Plantar fasciitis today is the most common cause and diagnosis of heel pain.  It refers to inflammation of the plantar fascia which is the band of tissue (ligament) underneath the foot.   It originates from the calcaneus (heel) as one band and then divides into medial, central and lateral bands all attaching onto the metatarsal heads of the metatarsal bones.  It basically attaches your heel bone to your toes. The plantar fascia plays an important role in maintaining and supporting the arch of the foot.

                                               Heel-pain

Plantar fasciitis has many factors that lead to inflammation of the plantar fascia but the majority of cases is related to biomechanical anomalies such as poor foot mechanics.   When the plantar fascia is overstrained, the fibres of the plantar fascia become weak and tear usually at the attachment site of the heel as this is the weakest area. This causes the fascia to swell and results in inflammation which elicits the pain.

Plantar fasciitis can affect all people from adults to children, old and young but is more common in adults. In young people it is more noticed in those who stand a lot on their feet and young athletes.

Heel pain is a common condition in which weight bearing on the heel causes extreme discomfort.

Signs and Symptoms

  • Pain in the heels mainly the plantar (underneath) surface of the heel.
  • ‘First step’ pain or pain with first couple of steps in mornings and then eases after a few steps
  • Pain in heels with movement upstairs and downstairs
  • Pain in heels when standing after sitting for some time
  • Pain when palpating heels especially the plantar centre and medial aspects of heels.

Diagnostic imaging with X-ray and Ultrasound modalities can confirm diagnosis of condition.  X-rays usually show the presence of heel spurs which is the site where the inflammation is present.  Ultrasound usually shows plantar fascial thickening which confirms the diagnosis.

Clinical Presentation

In addition to all of the above signs and symptoms associated with plantar fasciitis, plantar fasciitis presents clinically in three different pain areas around the heel bone and it is important for the Podiatrist to be able to distinguish this.  It can present as medial pain, central pain and lateral pain.  This is related directly to the anatomy of plantar fascia having three aponeuroses under the foot medial, central and lateral attachments.  

Medial heel pain is associated with excessive pronation more than what the body allows.  This causes the medial plantar fascia to elongate and tear away from the calcaneal attachment causing inflammation and pain.

Central heel pain is associated with high lateral heel strike in gait and excess pronation through midstance phase of gait, together with forefoot valgus deformity.  When the foot lands laterally, the ground reaction forces propel the foot into pronation as it enters midstance, causing middle and central plantar fascia tearing at the attachment and causing trauma at the pivot point.

Lateral heel pain is associated with a high arch foot which causes the lateral plantar fascia to strain from the attachment. 

                                                    Foot Doctor

Treatment

  • Reducing plantar fascial strain through correcting foot mechanics by the use of Custom made orthotics
  • Cryotherapy in the acute stages of the condition
  • Dry needling to reduce pain and soft tissue thickening
  • Prolotherapy injections to promote healing and synthesis of collagen fibres
  • Shockwave therapy to promote healing and reduce pain

Podiatrist Recommendations

  • If heel pain is experienced, seek professional advice by making an appointment with us as soon as possible.  Delaying treatment could affect the prognosis of the condition and delay recovery.
  • Avoid walking barefoot and with thongs.  Try to be in deep supportive shoes whilst most of the day
  • Avoid stretching of the plantar fascia in the acute stages of the condition as this will cause further tearing the fascia
  • If pain is getting worse day by day, see your GP or Bankstown Podiatrist for either a referral for Xray or Ultrasound.