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What is heel pain?

Are you or someone you know suffering with heel pain? Scared to take that first step in the morning or has it stopped you from enjoying walking and sports.

If you have heel pain you are in the company of many people who have foot pain, accounting for many visits to healthcare professionals – including podiatrists, physios and GPs. It is the most common foot disorder encountered by podiatrists (college of podiatry).

Who gets heel pain

Young children can get heel pain especially those who are active and sporty. Adults who enjoy running and high impact sports can get heel pain. Adults whose occupations require them to be on their feet for long periods are susceptible. As we age, the soft tissue within the heel can degenerate leading to heel pain.

What is the structure within the heel that can be injured

The heel consists of bone (calcaneus) and soft tissue structures that attach to the bone including tendons, fascia, ligament.

The foot is a key structure for walking and running and whilst it is very well designed to withstand such load, it can suffer from over -use, overload or degeneration. 

Causes of heel pain or injury

Degeneration of the soft tissue is the most common cause and in particular, Plantar heel Pain syndrome PHPS (commonly known as Plantar Fasciitis) especially amongst runners and those who stand for long periods at work.

Are you a runner?

PHPS is a degenerative condition rather than an inflammatory condition, and affects 10% of the population and 15% of all foot related complaints being seen by medical staff. 10% of all runners experience plantar pain and most common in those who run long distances.

Some of the common conditions include

  • PHPS
  • Baxter’s Nerve
  • Heel spur
  • Tarsal Tunnel Syndrome
  • Fat Pad Contusion
  • Distal Tear
  • Tibialis Posterior Dysfunction

How can we help

Treatment from a podiatrist will be tailor-made for each patient but likely to include advice, taping, stretching and strengthening exercises, orthotics, shockwave therapy, steroid injection therapy, night splints.

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Sever’s disease/Calcaneal apophysitis

Calcaneal apophysitis

This condition is also known after doctor who first identified it in 1912 It was called Sever’s disease which does sound rather scary. It is the most common cause of heel pain in children. Podiatrists regularly treat these common injuries when they affect a foot or ankle, at Zest we would recommend our MSK lead.

Symptoms of calcaneal apophysitis

In all growing children there are areas on the bone that are made up of special cells from which the bone will grow. These are called your growth plates or apophysis. The growth plate on the back of the heel bone (calcaneus) is situated where the Achilles tendon connects to it. Bones in children tend to grow quite quickly in comparison to other structures particularly tendons.

As parents can testify when their child goes through a growth spurt can be very quickly over a few weeks. These growth spurts are most prevalent between the ages of 9 and 11 which is the most common time to get calcaneal apophysitis and at the start of a new sporting season.

The shin bone (tibia) starts to grow but unfortunately the Achilles tendon, which does not have as good blood supply as the bone, cannot grow or stretch at the same rate. This means that the Achilles tendon becomes tighter and as they move it pulls with more and more force on the growth plate at the back of the heel bone causing the growth plate to become irritated.

Treatment

If left calcaneal apophysitis will eventually get better by itself within 2 to 4 weeks. But it can become very painful and last longer in which case your podiatrist can help. If the child is not in too much pain they can continue with their activities and use ice regularly on the area to relieve pain. In some cases, a heel raise, or orthosis will help and often stretches are used to help settle the condition more quickly.

The most important thing is to keep the child is comfortable as possible while this condition resolves. We often recommend daily use of trainers or walking shoes until the pain settles. Recurrence of calcaneal apophysitis is not uncommon with each growth spurt but should this occur your podiatrist will tell you how to deal with it. This same sort of condition occurs in other areas of the foot such as at the base of the fifth metatarsal where it is known as Iselin’s disease.

Lateral ankle sprain Post

lateral ankle sprain

Lateral ankle sprain is one of the most re-occurring injuries in sports. Often the first instance of injury is as a child with a twisted ankle that causes damage to the ligaments around the outside of the ankle. This means that the outside of the ankle has reduced ability and as you start increase your activities this instability becomes more pronounced.

The most common ligaments damaged in the ankle is known as the Anterior Talo-Fibular Ligament or ATFL for short. Its job is to prevent the foot sliding forward too much at the ankle during activity. Ultrasound is used as part of the clinical diagnosis in all of our MSK treatments.

Sprains of the ankle are often characterised into three grades with grade 1 being a stretching of the fibres of the ligament. Grade 2 being rupture of some of the ligament and grade 3 being total rupture of the ligament. The reason why it is the most re-occurring injury in sport is that is often not treated correctly at the time of injury. Unfortunately, once damaged the ligament rarely repairs.

Once you have recovered from the initial injury can often rear its head again through repeated minor strains or increase in pain around the outer part of the ankle on different activities. Sometimes this can occur during a change in activity or even something as simple as walking over an uneven surface.

Treatment of lateral ankle sprain

Treatment of lateral ankle sprain often involves using a strapping or ankle brace to prevent further injury but also initiating a rehabilitation/strengthening or exercise plan to help get the muscles around the ankle to do the job the ligament would have done.

Orthoses or insoles can always be used to help reduce the chance of re-injury. In severe cases, where the ligament is badly damaged but intact, we may need to use an ankle brace and/or orthoses long-term, in these cases injection therapy can also be used to help make the area pain-free to allow appropriate rehabilitation.

Achilles Tendinitis Post

achilles tendonitis

The Achilles tendon is the tendon that connects the calf muscles to the back of the heel bone. It is a key tendon in providing movement and power on walking. On occasions it can become irritated or thickened as a result of trauma or overuse, causing Achilles Tendinitis. Often changes in heel height of shoes, from high to low, can also create this irritation. During this irritation the Achilles tendon becomes thickened, stiff and painful, particularly on movement after sitting.

It is important to keep the tissues of the tendon moving so rest id not usually recommended unless in high levels of pain. Your podiatrist will be able to examine the area to determine if there is any tearing of the tendon a period of rest or possibly surgery may be required. This can be done using ultrasound imaging that is available in the clinic

Achilles Tendinitis treatment

Once the integrity of the tendon has been determined the podiatrist can then start you on your treatment plan.

This will usually involve stretches and strengthening of the tendon and the calf muscles themselves. In order to help you with this your podiatrist may recommend that we use orthoses to help distribute the stress and strain through the tendon evenly or occasionally strapping to allow you to continue to be active.

In cases of extreme inflammation may be indicated to perform injection therapy. This usually involves a period of immobilisation cast boot.

Given that the Achilles tendon does not have a great blood supply compared to muscles it can take some time to fully recover from injury.

Interdigital neuroma

ball of the foot

Interdigital neuroma

More commonly called Morton’s neuroma people often describe a feeling of like having a stone in their shoe or that their sock is wrinkled up under the foot. They can get pain and numbness with tingling or burning sensation occurring in the toes or cross the ball of the foot. Shooting pains can occur in extreme cases. The pain is more noticeable on walking or in wearing particularly tight or closed in shoes.

An interdigital neuroma is an irritation of the nerve that runs to the toes in between the long metatarsal bones of the foot. For instance whilst walking or where footwear issues are particularly tight the nerve can get pinched. After that the nerve becomes enlarged due to this repeated compressed by the bones of the foot. The condition can occur gradually over time getting worse and worse and causing more pain and discomfort.

Treatment

Your podiatrist will be able to examine the area and using some diagnostic tests therefore being able to tell you whether a neuroma is suspected. The specialist podiatrist here at Zest will often use a diagnostic ultrasound scan to identify the site and size of the enlarged nerve.

Treatment options include

  • footwear changes into wide deep shoes with a lace or strap
  • insoles to help widen the space in between the bones of the foot
  • ultrasound guided corticosteroid injection to help reduce the size of the nerve

The guided injection is by far the most successful treatment for this. In addition and in extreme cases the neuroma may have to be removed by surgical team.

Plantar fasciitis

plantar fasciitis

We use the term Plantar fasciitis to describe a type heel pain. Which results from the deterioration of your plantar fascia. However, today we prefer to call it plantar heel pain syndrome or plantar fasciopathy.

Plantar fasciitis symptoms.

Plantar fasciitis is characterised either firstly by initial step pain or secondly by a pain on weight-bearing after rest. It is a very common condition, for instance around 10% of the population will suffer at some point in their lives.

The pain is usually felt anywhere along the bottom of the foot is typically located underneath the heel. As mentioned previously it is worse first thing in the morning or after long periods of rest once the foot starts moving the pain normally decreases. Plantar fasciitis can occur in people of any age but is usually in adults.

Causes

It is usually as a result of a sudden change in the loading of the heel and its associated structures this can be due to:

  • changes in activity
  • poor footwear
  • sports injury
  • imbalance in the muscles of the legs or hips
  • tight calf muscles

Often other structures than just the plantar fascia can be involved such as the nerves or tendons around the inside of the ankle. Furthermore this can often give subtle changes to the type of pain felt in the heel. Your podiatrist will ask you about this during consultation.

Treatments

The specialist podiatrist here at Zest Podiatry will then have a look at the thickness of the plantar fascia and the integrity of the structures around the area using a diagnostic ultrasound imaging. If this confirms the diagnosis of plantar fasciitis then treatment options can be discussed.

These plantar fasciitis treatment options could include:

The Zest team here will take you through the pros and cons of each treatment option so you can make decision that is right for you.

What is Podiatry?

musculoskeletal

Podiatrists are foot healthcare experts.

They are university trained to prevent, diagnose, treat and rehabilitate medical and surgical conditions of the feet and lower limbs. The College of Podiatry.

Podiatrists (formerly named Chiropodists) are the healthcare professionals responsible for delivering podiatry both in hospital and clinic settings. They study a degree course and are registered with the HCPC (Health Care Professions Council).

They deal with a broad range of conditions that affect the foot and ankle. Treatments include specialist treatments such as swift microwave verrucae therapy, sports podiatry, injection therapy, musculoskeletal and nail surgery.

Foot health provision is available on the NHS to those who long term conditions that affect their feet. Conditions may include Diabetes, Peripheral Arterial Disease and Rheumatoid Arthritis (NICE guidelines).

We have 3 full-time and 2 part-time podiatrists who are able to provide general podiatry alongside musculoskeletal. We treat those in pain, have reduced mobility or just want to improve aesthetics. Musculoskeletal podiatry includes the use of ultrasound imaging, injection therapy, extracorporeal shockwave therapy (ESWT), Run3D and orthoses.

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