The heels of our feet are exposed to considerable force every time we take a step. Heel pain can have a significant impact on ones quality of life, and can in some cases become disabling. Alterations that occur in gait due to heel pain can also effect posture, causing pain elsewhere in the skeletal system, for example back pain.
There are many causes of heel pain, however by far the most common is plantar fasciitis (which is also sometimes incorrectly referred to as heel spurs). Other common causes of heel pain include fracture of the heel bone following trauma or due to decreased bone density (especially as we get older), systemic inflammatory conditions and arthritis, bursitis, cysts, prominence of bone at the back of the heel, nerve entrapments and neuromas. Heel pain that lasts more than 24 hours should lead you to consult a health care professional for accurate diagnosis and treatment if appropriate. All causes of heel pain are best treated in the early, rather than late stages.
For the purposes of this review of heel pain the most common type of heel pain, plantar fasciitis will be described.
Plantar fasciitis is a common cause of heel pain. It is most common in women over the age of 40. Predisposing factors include being over weight or increased levels of activity / jobs that involve higher levels of activity or standing for long periods. Other predisposing factors include having tight calf muscles which limit the forward bend of the ankle or certain types of arthritis, for example rheumatoid arthritis. The shape of the foot is also important, it has been noted that feet that are excessively flat or high arched are also at risk.
Plantar fasciitis can however occur to anyone at any stage in life.
Symptoms / Signs
The condition usually starts gradually with pain on standing after rest, under the heel bone. It is often most notable on standing first thing in the morning. The pain will then ease once you 'get going.' With exercise the pain in the early stages tends to occur after activity rather than during activity.
As plantar fasciitis becomes more chronic the pain can become more constant and can then start to effect the way you walk. This is turn can effect your quuality of life, mobility and posture. It is not uncommon for people who have suffered from plantar fasciitis for some time to develop other joint pains, most commonly in the knees, hips or back.
Though plantar fasciitis is a single diagnosis, the causes of plantar fasciitis is multi-factorial. There is no one single definitive treatment line, whether that be an insole / orthotic or surgery. It is important to be aware of the complexity of the condition and the need to identify the cause of your plantar fasciitis before a treatment line is devised.
In the early stages of plantar fasciitis rest, anti-inflammatory drugs, strapping and physical therapies may bring about a remission in the associated pain. However the pain is highly likely to occur if the cause of the plantar fasciitis has not been identified. Common factors that may need to be addressed include the way the foot interacts with the ground (the biomechanics of the foot), a reduction of the fatty padding of the heel, a tight heel cord (Achilles tendon), tight hamstring muscles, obesity or foot wear selection.
Orthotics are insoles that can be placed in your foot wear to alter the way the foot interacts to the ground and it's position to the leg. An orthotic can for example reduce the stress on the plantar fascia, reducing the likelihood of inflammatory changes.
Exercises can be used to again reduce the stress on the plantar fascia while walking, these may well be used in combination with orthotics.
Steroid injections can be carefully placed about the inflamed section of the plantar fascia. These can rapidly reduce inflammation in the area, though not a cure in themselves, they are a useful therapeutic adjunct.
In the later stages of chronic plantar fasciitis it maybe necessary to immobilise the foot for a period, in a type of cast. In some rare cases where conservative treatments have not been sufficient surgery can be used. The surgery involves isolating a small section of the plantar fascia and severing, to reduce the tension present on weight bearing.
Outcome / Prognosis
Over 70 % of all heel pain can be successfully treated with simple conservative treatment options. It is essential that an accurate diagnosis of the heel pain is established in the first instance and then the most appropriate treatment line selected. Heel pain is certainly best treated earlier rather than late. Less commonly surgery can be carried out to address plantar fasciitis, this is a simple procedure which usually has a good outcome.