Heel Pain & Treatment

Heel pain is common and affects all types of people from the sedentary and overweight to the fit and active.

Overview

Heel pain is common and results in millions of GP appointments worldwide. It can be seen in all types of people with symptoms seen in both the sedentary and overweight as well as the fit and active. Symptoms are often persistent and can result in a significant impact on the individuals quality of life.

Causes and Symptoms

Plantar fascia is a thick ligament that is attached to the bottom of the heel bone (calcaneus) and connects this to the ball of the foot. Its function is to help with propulsion of the foot through a windlass action across the arch of the foot.

What causes plantar fasciitis?

There are a number of risk factors for development of the condition. The most important predisposing factor is having tight calves. It is also seen in those with very high or even very low arches. Overuse activities such as running or occupations that involve prolonged standing or walking are also know to predispose you to the condition. Having a high body mass index has also been linked to developing the condition. Occasionally the symptoms can start after a single traumatic event such as a fall from height.

What are the symptoms?

Heel pain on weight bearing is the main symptom. The location of the pain may vary slightly between individuals but typically the origin of the plantar fascia on the inner aspect of the bottom of the heel bone is the focus of the pain. Pain is typically worse after a period of rest and disuse. Typically the first few steps out of bed in the mornings can be the worst. This is because the calf muscle tightens up when resting and having the foot relaxed and pointing down, so it may take a little while for things to stretch out in the morning. Swelling may occur but this would be an unusual symptom and if there is significant swelling then an alternative diagnosis may be the culprit. 

Diagnosis

X-rays may be recommeended to check for heel spurs.

Heel spurs are bony condensations underneath the heel bone and close to the origin of the plantar fascia. There has been much debate as to the relevance of these in relation to plantar fasciitis. What is clear, however, is that there are many people with heel spurs who have no pain and many with pain and no heel spurs. Removal of heel spurs therefore is not recommended in the treatment of heel pain.

Treatment

The bad news is that there isn’t a single simple cure for plantar fasciitis. The good news is that there are many treatments available that can improve your symptoms. Here at Schoen Clinic we are experts at managing this condition and have a multi-disciplinary team of surgeons and therapists who will be at your disposal to manage your pain.

Rest - this should be the first step in managing an acutely painful heel. For example, if running is the cause of your heel pain then stopping or reducing the amount you run should be the first step.

Physiotherapy - stretching and strengthening exercises of the calf muscle (gastrocnemius), the hamstrings and the hip and core muscles as well as specific plantar fascia rehabilitation can help ease symptoms.

Insoles or orthotics - depending on your foot shape and arch height, we may recommend specific insoles or footwear for you.

Night splints - if early morning pain is a major problem then sleeping with a splint which keeps your foot in an upward position can be very helpful. There are many types on sale but a Strasbourg sock is a simple one that most patients find easy to use.

Shockwave therapy - mechanical shocks applied to the painful area over a number of spread out sessions can be a very helpful modality with a good body of evidence behind it.

Injections - there are various injectables that can be considered such as cortisone (a type of steroid) or PRP (platelet rich plasma) that can be used. 

We will carefully assess your individual condition and symptoms to see if you are suitable for any of these treatments. 

Surgical treatment

Surgery is always the last resort. However, if your symptoms have failed to ease with non-surgical treatment and you have had severe pain for many months or years then we may recommend surgery. There are various surgical interventions available. Our preferred method is to release or lengthen the calf muscle through a small incision on the inside of your leg. We have had good success in treating recalcitrant cases of heel pain and our lead foot and ankle surgeon (Mr Ali Abbasian) has published on this technique and is nationally recognised for it.

Treatments are available at the following locations

Schoen Clinic London

Our Address
Schoen Clinic London
66 Wigmore Street
London W1U 2SB
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+44 (0)203 929 0801
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