Heel pain is very common in the adult population with 10% of people experiencing heel pain at some point in their lives. The most common causes for heel pain are described below.
The plantar fascia is the ligament that connects your heel bone to your toes. This connective tissue also supports the arch of the foot. Stress on the plantar fascia from repeated activity, such as running, can strain the ligament, even causing tiny tears. When this ligament is weakened or irritated, it swells and causes pain upon standing or walking. This is one of the more common causes of heel pain. There can be many contributing factors to the onset of plantar fasciitis, but biomechanical abnormalities in the way the foot functions is a major contributor. Muscle imbalances and misalignments of the joints cause an overloading of the ligament. We will determine the cause by combining a Biomechanical Assessment and Digital Video Gait Analysis, which will also assess your footwear. Treatment may involve padding/taping, foot mobilisation, a stretching regime and the use of functional foot orthoses if there is an abnormal biomechanical factor involved.
Some people have heel spurs that never cause any symptoms, but some people develop calcium deposits as a result of plantar fasciitis being left untreated over time. Often an x-ray is needed to determine if this is the problem, but treatment for heel spurs are much the same as those for plantar fasciitis.
Calcaneal Bursitis (Policeman’s Heel)
‘Policeman’s Heel’ is often confused with Plantar Fasciitis, but they are different. Policeman’s heel is Plantar Calcaneal Bursitis - an inflammation of the sack of fluid (bursa) under the heel bone. It is not as common as plantar fasciitis.
Both stress and complete fractures equal a calcaneal bursa in intensity and pain, so must be eliminated by x-ray or scan.
Plantar calcaneal bursitis can be caused by high impact forces so a good shock absorbing shoe is a must. The way your foot strikes the ground and the forces that are placed on it, can have a direct effect on causing plantar calcaneal bursitis and also delaying the healing times. We will determine your foot-type and recommend the correct trainer with the use of video gait analysis. If there is an abnormal biomechanical component the use of foot orthoses which can also combine shock absorption for the heel will be prescribed.
Insertional Achilles Tendonitis
Pain behind the heel has one main cause, which is irritation to the Achilles tendon where it inserts into the heel bone. This can be caused by inappropriate footwear, by running or walking too much in unsupportive footwear, by training errors and by abnormal biomechanical factors such as over-pronation. Tight calf muscles in combination with over-pronation can cause excessive stress to the insertion of the tendon on the bone. We will determine the cause using Digital Video Gait Analysis and Biomechanical Assessment and treatment may involve rest, ice, a temporary heel lift, an exercise programme and if necessary functional foot orthoses.
Calcaneal Apophisitis (Sever’s Disease)
Sever’s disease is a condition suffered by children, typically within the 9-14 year age group, it affects boys more than girls generally. At this age, children are growing rapidly and Sever’s disease is an inflammation of the growth plate in the heel bone. This is usually due to doing a high level of impact sports together with biomechanical dysfunction. In itself, the condition is self-limiting, but it is often impractical to keep children off sport for such a long period of time and is very easily treated by ensuring they are in the correct footwear, effective and correct stretching of the calf muscles and correcting any gait abnormalities with foot orthoses.