Heel pain

Heel pain (Plantar Fasciitis) is the most prevalent foot condition in South Africa. An estimated 200,000 people in the country are afflicted with heel pain. In some cases a heel spur may be present.

Other types of heel pain include Achilles Tendonitis and Bursitis whereby the pain is felt at the back of the heel. Young children can also be troubled with paediatric heel pain, also known as Sever’s Disease.)

Heel pain symptoms

"I wake up in the morning and feel a sharp, stabbing pain, right in the centre of my heel. After a while the pain subsides and comes back as a dull ache..."

The typical experience that heel pain sufferers have is a sharp, piercing pain at the bottom of the heel during the first steps each morning. The amount of pain varies. As a rule, pain is more intense following long periods of rest.

Characteristically, pain will diminish during the day as the thick connective tissue under the foot (plantar fascia) warms up and becomes more flexible as a result of movement. Overnight the plantar fascia shortens and becomes very tight, so that when you first get out of bed in the morning it causes an abrupt stretch to the tissue. The sudden pull causes significant pain and even micro-tearing. This also occurs after sitting at a desk all day, watching TV or while driving. People with heel pain may also experience stiff calf muscles as well as tightness in the Achilles tendons (at the back of the heel).

What causes heel pain?

Plantar Fasciitis is the most frequent cause of heel pain. The Latin meaning of Plantar Fasciitis is, “Inflammation of plantar fascia.” The plantar fascia is a long, thick and very tough band of tissue underneath your foot that provides arch support as well as connecting your toes to your heel. Each time you take a step, the arch slightly flattens to absorb impact. This band of tissue is normally quite strong and flexible but unfortunately, not everyone is equally lucky. Poor foot dynamics (such as over pronation) or weight gain may cause some people’s plantar fascia to stretch excessively each time their foot hits the ground. Over time, the fascia ligament begins to detach at its weakest point where it inserts into the heel bone (calcaneus).

Repetitive stretching from constant tension results in micro-tearing of tissue and swelling at the site where the plantar fascia attaches to the heel bone, causing heel pain. Whenever your foot is at rest, such as sleeping, sitting or driving, the plantar fascia begins to tighten up and becomes shorter. Micro-tears occur in the tissue when you stand up and the fascia is stretched very quickly. This is what causes the initial searing pain in the morning and after long periods of rest.

Injury to the fascia can eventually create a bony growth at the heel bone. This is called a Heel Spur or Calcaneal Spur. Spurs typically do not cause the pain but are symptomatic of the ongoing irritation.

Reasons for plantar fascia over-stretching include:

- excessive pronation (the inward rolling motion of the foot and lowering of the arch structure)

- prolonged standing or bearing weight at work

- sudden weight gain or pregnancy

- tight tendons and muscles in your feet and calves

- age over 45

Treatment options for Heel Pain

We live in an age with many treatments options. Some treatments are more successful than others.

Medical interventions

Cortisone-steroid injections

Cortisone is manufactured by the body but can be given as local injections into specific areas such as the heel. Cortisone is a potent anti-inflammatory and will work almost immediately. The relief is intense but it is temporary and additional injections are required every few months. Cortisone shots don’t treat the problem as much as they relieve the symptoms. The shots can be very painful.           

Shockwave therapy

Extra Corporeal Shockwave Treatment is used in the USA more than South Africa. It is legislated only for use in treating plantar fasciitis and tennis elbow. The theory is that shockwaves may bring new blood flow into the affected area and this blood brings in nutrients and oxygen for healing. Another theory is that the brain has “tuned out” the pain and the shockwaves initiate new trauma and inflammation to remind the brain to react and send out nutrients for healing. The treatments are quite expensive, costing over $1000.00 each and many insurance companies do not cover the expense.

Surgery

Surgery is generally not indicated for plantar fasciitis. Approximately 95% of people with plantar fasciitis can ease heel pain without surgery. Surgeons cut part of the plantar fascia ligament as a last resort for releasing tension on the ligament to relieve inflammation. Heel spurs will also be removed if present.

What you can do yourself...

There are many options for self-treatment before reaching out to a specialist. By following the suggestions listed below you have an excellent chance of easing your pain, finding relief and healing your fascia. This is especially true if your heel pain has been present for less than three months.

Rest or reduced activity

Given time and opportunity, the body is remarkable at healing itself. Inflammation is the body’s response to injury. Allow your body to bring in blood and nutrients to the inflamed area in order to heal the micro-tears. You must restrain from sports, running or walking long distances. Avoid hills and standing longer than necessary for a minimum of six weeks.

You must absolutely avoid walking barefoot especially on hard surfaces and especially first thing in the morning. The idea is to rest and pamper the injured area so that it heals completely.

Exercises

Flexible muscles are our best defense in relieving strain on the plantar fascia. Many people have tight calf muscles and Achilles tendons. These tight muscles change the natural pattern of our gait and exacerbate the pronation that causes Plantar Fasciitis. Tight muscles also increase the chances of other foot and leg injuries. Click here for a sequence of helpful exercises.

Ice and Anti-inflammatories

Apply ice packs two to three times daily, placing the ice directly on the heel. Keep in place for 5-10 minutes. This reduces inflammation and provides relief from pain. Inflammation may also be decreased with anti-inflammatory medications such as Ibuprofen (which can be found in Advil and Nurofen). These medications, along with the ice, will reduce inflammation caused by micro-tearing of the plantar fascia. Voltaren Rapid is a powerful anti-inflammatory useful for relieving

Support your arches with orthotics

Orthotic insoles to support and realign your arches are recommended by physicians, podiatrists and physiotherapists. Orthotic insoles treat the root cause of the heel pain, which is improper foot dynamics. The gait caused by over-pronation causes a walking pattern than injures your plantar fascia. Wearing orthotic arch supports is a solution that changes the physics causing the micro-tears.

Summary:

Definition: Heel Pain (medical term: Plantar Fasciitis)

Symptoms: sharp pain in the heel with first steps in the morning or after resting, subsiding to dull ache

Cause: inflammation of the plantar fascia at the attachment to the heel bone

Treatment: orthotic insoles to correct pronation; daily exercises; rest or reduced activity

plantar fasciitis - planter fascitis

How orthotic insoles help relieve heel pain

Orthotic devices are designed to correct the alignment and physics of your gait. They are not the same as inexpensive gel footpads or rubber comforters that cushion your feet without providing biomechanical correction. Gel pads can actually work against you and make walking patterns worse.

When we take a look at people's feet we find that in most people, the arches look quite normal. What you can’t see, is that when walking and running, the arch and ligaments of the feet are being stretched to the point of injury. Your arches act as shock absorbers, mitigating the extreme, jarring energy of your body’s weight each time it comes down on your feet. If you consider the mass of the body to the size of your foot, a considerable amount of force is applied with each footfall. Orthotic insoles strengthen the arch while re-aligning the physics of the ankles and lower legs. Orthotic insoles reduce the tension on the plantar fascia protecting it from over extension and tears. This allows the inflamed tissues to heal.

By performing daily exercises and wearing standard orthotics, the American Orthopaedic Foot and Ankle Society found that 95% of patients with heel pain experienced significant long lasting relief from their symptoms. Orthotic devices needn’t be expensive, custom-made inserts. Heel Pain research studies by other groups have proven the value of orthotics and exercise in treating heel pain.

Australian podiatrists have developed Footlogics supports that protect the arch and enormously reduce pulling forces on plantar fascia. The basic premise is to treat the root cause of the heel pain, which is stretching of the fascia tissue. Footlogics also provides heel pads to absorb the tremendous shock and impact of each footstep on the painful heel. The overall principle is to remove the opportunity for new injury while cushioning existing painful injuries so that they may heal. Recommended by GP's, podiatrists and physiotherapists, Footlogics orthotics have helped many thousands of heel pain sufferers in Australia, Europe and the USA. Watch this heel pain video..

Recommended orthotics for heel pain: