Common causes and symptoms of heel pain.
Heel pain is a common condition that affects approximately 10 percent of people at some stage during their life. Heel pain can get in the way of life and affect wellbeing, mental health, and quality of life.
Discomfort or pain at the base of your heel is commonly referred to as planter fasciitis or spur syndrome. The most common symptom is heel pain. This is most prevalent after rest and the pain is located at the base of the heel which can be worse first thing in the morning. Pain will often subside partially throughout the day and return towards the end of the day or after rest periods.
What is plantar fasciitis?
Plantar Fasciitis is an overuse injury commonly caused by repetitive straining of the plantar fascia ligament at the base of the heel. The plantar fascia ligament connects to your toes through the arch of the foot and stabilises your feet. In the early stages of the of the condition, there may be inflammation, however, more severe cases we may often see a degenerative change in the ligament. This is where it become more difficult to treat successfully.
Early signs; Usually in the first month or so, pain is localised. Pain usually starts at the base of the heal and is more prevalent at the beginning of your day or after periods of rest. This is the best time to act and seeing your podiatrist for a treatment plan will help prevent further damage.
In the instance of a more chronic condition, the ligament may be presenting with micro tears or partial tears. This pain is most commonly felt radiating from the base of the heal and through the arch of your foot. It is crucial that we thoroughly investigate and treat accordingly. Non-invasive ultrasound is proven to assist with diagnosis and can often be the quicker option when diagnosing.
In some cases, plantar fasciitis may not be the cause of your heel pain. You should seek further evaluation ASAP if your symptoms include:
- Pain during the night
- Swelling or redness around the heel or leg
- An inability to support weight on your foot
- Morning pain that does not decrease during the day
How is plantar fasciitis diagnosed?
Plantar fasciitis can be diagnosed quite easily through a thorough clinical consult. Your podiatrist or general practitioner will talk to you about your history; previous injuries or issues, exercise programs, work life, day to day behaviours etc. To assist with the diagnosis, you may be required to have an ultrasound or x-ray.
Ultrasound is a non-invasive scan to assess the anatomy of the heel and ankle. Thickening of the plantar fascia connection point, along with micro-tearing or inflammation. Inflammation of the affected area is a typically sign seen on ultrasound which can confirm the diagnosis of plantar fasciitis or a torn plantar fascia.
X-ray may reveal more details for diagnosis. Heel spurs, which is often present in cases of chronic heel pain will show up on these images. Heel spurs develop as a response to excessive stress on the bone of the heel. While not all people with heel spurs develop heel pain, these spurs can indicate elevated pressure and strain on the plantar fascia ligament which can predispose people to developing heel pain.
Common factors that can contribute to heel pain
Plantar fasciitis typically develops between the ages of 35 and 75. As we age, our tendons and ligaments become less flexible and capable which increases the risk of developing conditions such as planter fasciitis, Achilles tendinitis, tennis elbow, and rotator cuff injuries.
Sudden increase in activity
When physical activity increases faster than the body's ability to adapt or recover. This overload on the body’s tendons and ligaments can lead to overuse injuries which is often the case in heel pain.
Carrying a few extra kilos puts additional stress on the body’s joints, ligaments, and tendons. Carrying additional weight also impacts hormone balance, which can in turn reduce the body's ability to heal overuse injuries such as plantar fasciitis.
It should be no surprise that inadequate sleep impairs the body's ability to repair and regenerate. A good night’s sleep is important to allow your body to repair cellular damage caused during the day. If you are having trouble sleeping, some simple adjustments you can make include:
- Reducing caffeine intake
- Dimming the lights in your house 1-2 hours before bed
- Avoiding any screen time for 2 hours before bed
Shoes that are too flexible or flat increase strain on the arch during walking and running. It is important that your shoes have a firm, supportive heel and some stiffness through the midsole. If you can bend your shoe in half, as a general rule the shoe is not providing good support to the foot arch. A good, supportive shoe should have a firm heel to provide optimal support to the heel and ankle. In general, the worst type of shoes for plantar fasciitis are very flexible and very flat.
Genetics – Foot type
If there is too much stiffness or too much flexibility, this can increase the strain on the foot arch and contribute to plantar fasciitis. This is often the case in ‘flat feet’ or ‘fallen arches’, but also in those with high arches.
If you don’t use it, you lose it. A sedentary lifestyle or work environment can increase your risk of developing plantar fasciitis. Inactivity can reduce the load capacity of the tendons and ligaments, increasing their risk of injury.
Steps you can take to control your heel pain
Wear appropriate footwear
Over years of treating patients as a podiatrist, I have often found that the patient's footwear is inappropriate and contributes to the development of their heel pain. Addressing your footwear is essential if you tend to walk around in flat, loose, unsupportive shoes. Wearing a lace-up shoe with good arch support is often the first step that I recommend for my patients. Wearing supportive footwear is essential to reduce unnecessary strain on the arch of the foot. It is important to find a shoe with a firm heel counter that provides ankle support. Stiffness through the shoe’s midsole is essential to reduce pressure on the arch, but it is also important to be able to adequately bend the big toe joint during walking and running. It is also necessary to make sure the shoes have good cushioning and aren’t too heavy.
It is vital to evaluate if any particular activities seem to be aggravating your heel pain. Lots of walking up and down stairs or ladders are also typical factors that contribute to heel pain. Plantar fasciitis can also be seen in occupations that involved standing for many hours at a time, particularly on hard surfaces.
I generally never recommend patients stop walking entirely. However, if you’re developing heel pain and walking or running is contributing to that, it may be necessary to reduce the amount of running and increase the recovery time between exercise sessions. For instance, if you typically go for an hour-long walk each day you might break it up into 2 half-hour walks with a rest in between. Modifying your exercise may also include switching to swimming and bike riding, which typically do not aggravate plantar fasciitis.
Plantar fasciitis commonly causes pain towards the end of the day, particularly when you start walking following a period of rest. Icing is a great way to reduce inflammation and pain. I recommend icing the heel for 10–15 minutes every hour as needed. Another great trick is to freeze a plastic bottle of water. By using the frozen bottle to roll under the arch and heel, we are addressing two factors by both massaging and also icing the heel and arch.
Stretching and exercises
Restricted movement at the ankle joint or big toe joint is often a contributing factor in the development of heel pain. This is because restricted movement at these joints results in overcompensation during walking. If the movement is blocked, the body needs to find an alternative way to move. The problem with these compensations is that repetitive activity such as walking can create additional stress in certain tissues, resulting in them breaking down and causing pain.
When stretching the ankle or the big toe joint, noticing that the motion hits a hard point and will not go any further suggests that there is a bony block which is stopping the joint from moving properly. In this case, stretching will not improve the motion at the joint and it is important to have it assessed by a podiatrist or experienced physical therapist. There are specialised techniques which can help improve the movement in these joints.
Unfortunately, a significant number of people find that home treatment methods such as stretching, icing, and massage are insufficient to significantly reduce the pain and allow them to enjoy daily activities without pain. If the pain you are experiencing is impacting your daily life and does not improve with simple measures, it is essential that you are assessed by an experienced sports podiatrist. It is vital to understand the specific risk factors that are involved in your experience of chronic heel pain. Failure to properly identify and adequately address these factors will delay healing.
Treatment of heel pain depends of the severity and individual causative factors. At My Sports Podiatrist, the treatment options we provide include:
- Swiss DolorClast® (Shockwave Therapy)
- Regenerative Injections
Seek expert opinion ASAP. The earlier the intervention, the better the outcome.
Mr James Ferrie
B. Pod. (La Trobe); Mem. A. Pod. A
Principal Practitioner / Founder of My Sports Podiatrist