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Plantar Heel Pain

Pain under the heel is a very common injury, in fact, heel pain is the most common of human foot complaints. Over 80% of Australians will have this problem at some point in their lives, and therefore, proper diagnosis and appropriate treatment of heel pain and heel spurs is extremely important.

Do you experience any of the following?

  • a painful heel or bruising feeling first thing in the morning;
  • throbbing heel at the end of the day;
  • stiffness/soreness when standing up after sitting;
  • stabbing heel pain or dull ache during/after activity; or
  • bruising pain under the heel with extended standing.

If yes, chances are you are suffering from plantar heel pain which can be associated with any of 4 different injuries around the heel.

It is important to diagnose the cause of your heel pain and direct your treatment plan accordingly. The wrong diagnosis can lead to a longer recovery from the injury than is required. This is why it’s important you seek professional advice for your plantar heel pain.

What are the 4 main types of pain under the heel?

Plantar Fasciopathy is an inflammation of the origin of the fascia at the calcaneus (heel bone). It usually presents on the anteromedial aspect of the plantar heel. It is a result of the repetitive strain, tear and repair of the fascia from traction forces. It is like an elastic band that is repetitively stretched many times; it loses its stretch and has many micro- tears in it. Inflammation and tears of the plantar fascia can also occur in the arch through the mid portion of the plantar fascia.

Fat Pad inflammationbeneath our calcaneus (heel bone) we have a fat pad which acts as a cushion when our heel strikes the ground. With repetitive trauma to the heel or even just one significant heavy loading event this can become inflamed and feels like a bruising under your heel.

Stress reaction of Heel bonewith repetitive strain of the plantar fascia pulling on its attachment to the calcaneus (heel bone) this attachment and surrounding area can become inflamed and if unchecked can continue into a stress reaction.

Nerve Entrapmenta nerve, called the medial calcaneal nerve, runs alongside the bones, muscles and fascia around the inside and under the heel. This can become trapped and feel like a sharp shooting pain under the heel which can sometimes radiate down the foot.

Who is more likely to develop heel pain?

  • People with flat feet;
  • People playing sports with excessive impact (running, jumping, dancing etc);
  • People with previous foot / ankle injuries (altering normal foot function);
  • People with standing/walking occupations;
  • People with poor footwear; or
  • People with high body mass index.

What causes heel pain to develop?

  • Faulty foot function;
  • Changes to training surfaces/ training loads;
  • Footwear
  • Returning to activity after a period of rest; or
  • Increasing activity loads through your feet too quickly.

What can I do about my heel pain?

Conservative Options:

  • Address your footwear;
  • Stop the aggravating activity;
  • Offload, Rest, Ice, Tape;
  • Soft Tissue Massage;
  • Stretching and Strengthening exercises;
  • Orthotics;
  • Night splints;
  • Heel Cushions; or
  • Some alternative therapies Shock Wave Therapy, PRP, RFD.

A multi-modal approach with the correct combination of the above options will fix 90% of people.

Invasive Options:

Depending on the exact reason for your heel pain there are several invasive options should conservative management options fail to achieve the desired results, including:

  • Cortisone injection; or
  • Surgery to correct foot structure and function.

For further advice and to correctly diagnose your heel pain book an appointment today by calling 1300 859 887.

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