Plantar Heel Pain Archives - Balance Foot Studio

Do you think you have a heel spur? Are you suffering heel pain? Getting the correct diagnosis for your heel pain is the first step in getting better!

Following on from our first Plantar Fasciopathy blog, here at Balance Foot Studio we strive to educate and empower our patients their foot health journey - with the next instalment in our “Heel Pain" blog series: "Heel Spurs".

We can't tell you how often people come in to see us with a sore heel and declare “I have a heel spur” not knowing what a heel spur is, or if they actually have one!

If you've always wondered what a heel spur is - well look no further! Our aim is to educate you about what it is, what treatment to expect to manage this painful condition and sometimes debilitating condition. We will bust some of the myths surrounding heels spurs and what's really behind this form of heel pain.

Do I Have A Heel Spur?

We can't tell you how often people come in to see us with a sore heel and declare “I have a heel spur” not knowing what a heel spur is, or if they actually have one!

– Are you suffering from heel pain right in the centre of your heel? –

– Does it feel like you’re walking on a “stone” or feels “bruised”? –

– Does it hurt whenever you’re walking on it, especially if you walk over uneven surfaces? –

- If you are experiencing one or all of these symptoms, you may have a heel spur -

How Does It Differ From Plantar Fasciopathy (plantar fasciitis)?

Firstly, a boney spur is the additional ossification (bone formation) caused by traction. This is the caused by ongoing and continual irritation of one spot, resulting in excess bone growth. A heel spur occurs when the soft tissues attached to the calcaneus (heel bone) are overused, continually pulling on the calcaneus and irritating this area. While this irritation and overload continues and if not addressed, it can result in a small spike of bone protruding from the calcaneus. It was often thought the heel spur occurred when the plantar fascia pulled on the calcaneus. However it is now considered to be from the origin of a muscle under the foot called Flexor Digitorum Brevis (FDB). The FDB originates from the centre of the heel bone.

The main origin of the plantar fascia is on the medial (inside) aspect of the calcaneus. Thus, the FDB originates from the centre of the calcaneus, exactly where a heel spur occurs. It’s associated muscles insert into the toes to flex (curl) the toes.

Does My Heel Spur Cause My Heel Pain?

Surprisingly, heel spurs very rarely are the true cause of heel pain. Unless you have a very large heel spur, which is uncommon. The pain is ultimately from inflammation in the soft tissue around the heel spur. Therefore you can live pain-free with a heel spur, however the issue is the inflammation around it that needs to be managed in order to alleviate the pain.

As such, a Podiatrist will need to assess & determine WHY the soft tissue is being aggravated and manage it accordingly. Very occasionally heel large spurs (around 10mm) don’t respond to conservative treatment and surgical intervention may be required.

This is always a last resort!

The core issue of why the heel spur and associated inflammation has developed in the first place needs to be addressed. Your Podiatrist will conduct an in depth biomechanical assessment - looking at your foot posture, joint range of motion and how you move (to name a few). This is done to determine the underlying real cause for your pain.

How Do I Manage Heel Pain? Getting The Correct Diagnosis Matters!

So you might be thinking, if there is a sharp piece of bone under my heel that I am walking on, how can I treat it? Firstly, as there are many forms of heel pain it is important to have the correct diagnosis for the best treatment options. To diagnose this condition, at Balance Foot Studio, we do a thorough examination of your foot and lower limb along with your history and site of pain.

Once diagnosed, treatment includes short term strapping to reduce the load on the soft tissues under the foot and to increase protection over the painful site. This is done by using tape to gently move the natural fat padding in your heel over the spur to help cushion the area. Cushioned heel lifts are often prescribed to help with the pain. There are two reason for this; the extra height in the shoe helps alleviate the force on the heel as your heel makes ground contact and secondly it gives shock absorption to help cushion the painful site. Sometimes a hole can be cut in the heel lift to take the pressure completely off the heel spur. This treatment is only temporary and we aim to get you out of the heel lifts by gradually reducing the height in your shoe, if necessary.

Appropriate stretches and strengthening is prescribed depending on the individual, but common exercises prescribed are:

Calf stretches - as prescribed by your Podiatrist.
Appropriate footwear - to reduce the load on the heel.
Strapping/taping - to support the foot/feet & reduce the strain on the soft tissues, allowing time to heal.
Non-weight bearing exercises - calf resistance strengthening & progressing as suitable
Intrinsic foot muscle exercises - These are now commonly prescribed to help strengthen the muscles in the foot to be able to withstand the load and in turn reduce pressure off the heel.
Short term NSAIDs (non-steroidal and-inflammatories) may also be advised early in the diagnosis to help reduce initial inflammation.
Depending on foot function, orthotics are sometimes prescribed to help realign the the foot and reduce the stresses on the soft tissues. This in turn can reduce or completely resolve the pain.
Injections such as cortisone, prolotherapy, PRP injections may help relieve some of the symptoms.
Only if all conservative treatment options have proven unsuccessful surgery is considered. Surgery may involve removing the spur from the bone, though it can also involve releasing the plantar fascia or other involved soft tissue.

Would You Like To Resolve The Pain Permanently?

Contact Balance Foot Balance for a professional and caring assessment. We are here to help and guide you through your heel pain. We will ensure you are diagnosed correctly and implement a tailored treatment plan. Let us help you get the spring back into your step!

Questions? Concerns?

Call us on: 6331 4885 for an appointment, or book online: https://balancefootstudio.com.au/make-a-booking/ Come and chat with our friendly Podiatrists if you have any questions.

Pain in your heel? Learn the real deal about a common heel pain condition - Plantar fasciitis (fasciopathy).

What it is, the causes & appropriate Podiatry treatment. At Balance Foot Studio, we want to empower our patients to understand heel pain in order to get the best outcome for your health.

Are you suffering from heel pain?
Do you wake up in the morning, stand up and lie straight back down again (not just because you want a lie in) but because you forgot how painful your foot was?
Do you feel that once you start moving around the pain eases and it “feels” better?Then the pain comes back again after you rest or after long bouts of weight bearing or exercise?
Do you think because it gets better during the day that it will go away? But alas, it returns the next day?

You may have “Plantar fasciopathy” - commonly referred to as Plantar fasciitis.

Plantar fasciopathy can be a debilitating condition that causes heel pain and without early intervention and treatment, can get worse rapidly. This can mean even everyday tasks like shopping and gardening become difficult. It can stop you from doing the sports you love or your daily walks around beautiful Launceston.

For a long time this condition has been called “Plantar Fasciitis” - with connotations that the affected structure becomes inflammed. It has since been found that the condition causes thickening or ‘fibrosis’ of the plantar fascia tissue and degeneration of the collagen structure but NO evidence of inflammation. As the “-itis” at the end of a word means inflammation and there isn’t any present, the more accurate terms now used interchangably are Plantar fasciopathy/fasciosis.

These terms fit better now that we have a more in depth understanding of the condition - namely where degeneration of the fascia occurs, rather than inflammation. Inflammation may still occur, however this is in the surrounding soft tissues. In extreme cases tearing can occur, which is likely to cause inflammation, however this would usually be secondary to the original complaint.

However, let's not get too bogged down with the "correct" terminology. A painful heel is a painful heel and our aim with this blog is to create a better understanding of the condition so that you may become pain free!

Fascia - What is it?

In order to eradicate heel pain / plantar fasciitis we need to understand a little about what "fascia" is.

Fascia is fibrous connective tissue. Its purpose is to surround muscles and vascular bundles (blood vessels) to hold some of these structures together while allowing others to move freely. They are similar to ligaments and tendons however, they surround muscles rather than ligaments that join from bone to bone and tendons which, join muscles to bones. We have them in various parts of our bodies and a major one that commonly causes problems is the plantar fascia. The Plantar fascia is located in the soles of our feet. It originates from the heel bone (calcaneus) and inserts into the ball of the foot.

Plantar fasciopathy (plantar fasciitis) is a condition where the plantar fascia gets overused, irritated and over time can start to thicken. This is also an area that starts to loose blood supply as early as in your 30s, which makes it more vulnerable to injury.

When you rest the fascia relaxes and shortens, so when you stand it pulls on the heel bone (calcaneus) and causes heel pain. Even though it eases as you walk, if you continue to overuse it you are actually exacerbating the injury. This type of injury is often brought on by repetitive type sports or activities, most commonly walking/running. Symptoms can also be felt if you have either suddenly increased your level of activity, especially if you suddenly start doing excessive weight bearing exercises multiple times a week, without gradual build up. Jobs such as nursing or construction where you are on your feet all day, especially if you are standing on hard or concrete floors, can increase your risk of Plantar fasciopathy. It can also transpire after a traumatic event, such as rolling your foot off the kerb, falling in a pot hole or coming off a ladder.

Please don't rely on "Dr Google"!

If you think you may be suffering from this condition, first and most importantly it should be diagnosed by a Podiatrist. There are various other pathologies that can cause plantar heel pain and it is important to know the correct diagnosis before you start a treatment regime. This condition is often “Dr Googled” and misdiagnosed, causing more harm than good. So next time you feel tempted to Dr Google, PULL THOSE FINGERS AWAY from the keyboard and see your Podiatrist instead! Book online with one of our friendly & professional Podiatrists!

https://balancefootstudio.com.au/make-a-booking/

What causes Plantar fasciopathy?

The exact cause of Plantar fasciopathy is poorly understood and multifactorial. Altered biomechanics is believed to contribute to the onset of this condition through a decreased ankle joint range of motion. Reduced movement of the ankle (dorsiflexion) is one factor for the development of chronic Plantar fasciopathy. Calf muscle tightness has been implicated in several foot and ankle conditions, including Plantar fasciopathy. This is one reason why it is important to seek out a professional to help diagnose and treat this condition. Our Podiatrists at Balance Foot Studio will get to the bottom of the issue and create an individualised treatment plan focussing not just on your reducing your symptoms, but also the true cause of the condition.

How is it diagnosed?

Podiatrists are experts in diagnosing this and other soft tissue injuries. This is done with a number of diagnostic tests including taking a thorough history, visual examination, physical assessment and site of pain. Once diagnosed a treatment plan can be formulated to reduce pain and get you get back to your day to day activities and/or sports. All treatment plans are made on an individual basis and are dependent on cause and severity of pain.

Treatment:

The treatment for heel pain/plantar fasciitis (fasciopathy) may include:

Short term strapping to reduce the load on the area and realign the foot. This is usually done in conjunction with strengthening exercises and gentle stretching.
Strengthening/loading exercises are fundamentally the most important part of the treatment in order to reach full recovery. A tailored treatment plan is vital to ensure we are increasing load and or resistance training at the correct intervals for optimal healing.
Short rest periods may be required but we strive to get you back on your feet and returning to your sports as quickly as possible.
Sometimes activity modifications for sports and weight bearing exercise are implemented to allow for full recovery. This may include cycling or swimming or lower impact exercise, instead of running for example. Or reducing the number of times per week that you run and/or reducing the distance. The premise behind this is that you can still be active and maintain your fitness without weight bearing to allow healing to occur. It’s important to remember, in order to build strength.
Footwear advice may be provided if deemed appropriate by your Podiatrist.
Orthotics/orthoses are used in some cases to help re-align and support the foot during recovery. This is normally used as short term aid in recovery for around 4-6 months but may be up to 12 months. Longer term use can also be advised depending on foot structure, foot posture and alignment. This can be determined through a comprehensive biomechanical assessment performed in our studio by Sinead and Fiona. During this assessment your Podiatrist will conduct an extensive gait analysis (how you walk) along with joint range of motion, alignment and muscle testing. After the assessment your Podiatrist will be able to determine the best treatment protocol for you.

If you have been suffering from plantar heel pain, you may have decided after reading this that it may be plantar fasciitis/fasciopathy and want a professional assessment, diagnosis and treatment plan from an experienced Podiatrist, look no further and contact us today. The faster we get onto the problem, the quicker and easier it is to resolve the pain for you!

Call (03) 6331 4885 for an appointment today, or book online. Our Podiatrists are here to discuss any questions or concerns and to guide you through the best treatment plan based on your individual needs.

Heel Spurs