Written by Mr Nima Heidari-Khabbaz for Doctify

Heel pain is a very common problem and an estimated 1 in 10 people will have at least one episode of heel pain at some point in their life. In most cases, only one side is affected but around a third of those affected have pain in both heels. It usually builds up gradually and gets worse over time.

What are the symptoms?

The pain is usually at its worst first thing in the morning, or when you first take a step after a period of inactivity. It is usually described as being stiff. Walking usually improves the pain, but it often gets worse again after walking or standing for a long time.You may limp or develop an abnormal walking style as you try to avoid placing weight on the painful heel.

And the causes?

Plantar fasciitis is the most common cause of heel pain. The plantar fascia (the correct term is the plantar aponeurosis!) is a band of tissue in the foot which becomes damaged and thickens.

The plantar aponeurosis is a tough and flexible band of tissue that runs under the sole of the foot. It connects the heel bone with the bones of the foot, and acts as a kind of shock absorber to the foot.

Damage to the plantar aponeurosis is thought to occur following:

  • Sudden damage – for example, damaging your heel while jogging, running or dancing; this type of damage usually affects younger people who are physically active
  • Gradual wear and tear of the tissues that make up the plantar fascia – this usually affects adults who are 40 years of age or over

These can cause the plantar aponeurosis to thicken, resulting in heel pain. Some risk factors are associated with heel pain including being overweight,  having a job that involves spending long periods of time standing and wear flat-soled shoes.

How to diagnose heel pain

A thorough examination and set of tests are necessary to make sure your heel pain is not due to one of the more unusual causes. After a consultation and full examination of your foot further tests including:

  • Blood tests
  • X-rays  
  • A magnetic resonance imaging (MRI) scan or ultrasound scan – which are more detailed types of scan may be necessary

What treatments are available

Treatment for heel pain usually involves using a combination of techniques, such as stretches, painkillers, injection to stop severe pain to allow physiotherapy and modification of foot wear.

Most cases of heel pain get better within 12 months. Surgery may be recommended as a last resort if your symptoms don’t improve. Only 1 in 20 people with heel pain will need surgery.

 

heel-pain

 

Can exercise help?

Exercises designed to stretch both your calf muscles and your plantar aponeurosis should help relieve pain and improve flexibility in the affected foot. I will refer to a physiotherapist to monitor your progress as you rehabilitate.

A number of stretching exercises are described below. It’s usually recommended that you do the exercises on both legs, even if only one of your heels is affected by pain. This will improve your balance and stability as well as relieving your heel pain.

Towel stretches: Keep a long towel beside your bed. Before you get out of bed in the morning, loop the towel around your foot and use it to pull your toes towards your body, while keeping your knee straight. Repeat three times on each foot.

Wall stretches: Place both hands on a wall at shoulder height, with one of your feet in front of the other. The front foot should be about 30cm (12 inches) away from the wall. With your front knee bent and your back leg straight, lean towards the wall until you feel a tightening in the calf muscles of your back leg. Then relax. Repeat this exercise 10 times before switching legs and repeating the cycle. You should practise wall stretches twice a day.

Stair stretches: Stand on a step of your stairs facing upstairs, using the banister for support. Your feet should be slightly apart, with your heels hanging off the back of the step.Lower your heels until you feel a tightening in your calves. Hold this position for about 40 seconds, before raising your heels back to the starting position. Repeat this procedure six times, at least twice a day.

Chair stretches: Sit on a chair, with your knees bent at right angles. Turn your feet sideways so your heels are touching and your toes are pointing in opposite directions. Lift the toes of the affected foot upwards, while keeping your heel firmly on the floor.You should feel your calf muscles and Achilles tendon (the band of tissue that connects your heel bone to your calf muscle) tighten. Hold this position for several seconds and then relax. Repeat this procedure 10 times, five or six times a day.

Dynamic stretches: While seated, roll the arch of your foot (the curved bottom part of the foot between your toes and heel) over a round object, such as a rolling pin, tennis ball or drinks can. Some people find that using a chilled can from their fridge has the added benefit of helping to relieve pain. Move your foot and ankle in all directions over the object for several minutes. Repeat the exercise twice a day.

What shoes are best to wear?

You should avoid wearing flat-soled shoes because they won’t provide your heel with support and could make your heel pain worse.Ideally, you should wear shoes that cushion your heels and provide a good level of support to the arches of your feet. You can also use orthoses, which are insoles that fit inside your shoe to support your foot and help your heel recover. If you have an abnormal foot shape or structure, custom-made orthoses are available. These are specifically made to fit the shape of your feet.

Splinting

Night splints, which look like boots, are designed to keep your toes and feet pointing up while you’re asleep. This will stretch both your Achilles tendon and your plantar aponeurosis, which should help speed up your recovery time.

Corticosteroid injections

Corticosteroids are a type of medication that has a powerful anti-inflammatory effect. They have to be used sparingly because overuse can cause serious side effects such as rupture of tendons and the plantar aponeurosis. It is usually recommended that no more than three corticosteroid injections are given within a year in any part of the body.

Will I need surgery?

In about 1 in 20 cases, the above treatments aren’t enough and surgery may be needed to lengthen the Achilles tendon if this is a contributing factor.

Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. It involves using a device to deliver high-energy sound waves into your heel. The sound waves can sometimes cause pain.

It’s claimed that EST works in two ways. It’s thought to:

  • Have a “numbing” effect on the nerves that transmit pain signals to your brain
  • Help stimulate and speed up the healing process

However, these claims haven’t been definitively proven.

The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states that there are no concerns over the safety of EST, but there are uncertainties about the effectiveness of the procedure for treating heel pain.

Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).

Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet can be beneficial for your feet.

Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes without heels.


 

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