Heel Pain

Heel pain is a common and often debilitating condition. The pain can begin mildly, keeping you away from sport and activity, but without treatment this can worsen, commonly leading to time off work as a result of constant pain leading to a loss of income. There are many different causes of heel pain, with some of the more common diagnoses including:

  • Plantar fasciitis (also referred to as a ‘heel spur’)
  • Achilles tendinopathy
  • Retrocalcaneal Bursitis
  • Sever’s disease (in children)

In order to accurately diagnose your problem your podiatrist will conduct a thorough physical examination, watch you walking and may require you to get x-rays or other types of scans. Prahran Foot Clinic sees new cases of heel pain on a daily basis and can provide effective treatment during your first consultation.

These X-Rays display heel spurs on the bottom of the heel (centre image) and on the back of the heel (right image)

Plantar Fasciitis

Plantar Fasciitis is the most common cause of heel pain in adults seen at Prahran Foot Clinic. Caused by inflammation of a band of soft tissue under the foot known as the plantar fascia, the most common symptoms are a sharp or bruising pain under the heel, usually worse with the first few steps of the day and often returning later in the day or after prolonged sitting/resting. There are usually several factors that contribute to the onset of plantar fasciitis. Some of these underlying causes include poor foot posture (i.e. flat feet), unsupportive shoes, increased activity and excessive weight.

Around 85% of cases will resolve with conservative, non-invasive treatment. Treatment will begin during your first consultation at Prahran Foot Clinic. Reducing heel pain in plantar fasciitis is achieved by addressing both the underlying causes mentioned above as well as managing the accompanying pain. Custom orthotics, night splints, supportive strapping, therapeutic ultrasound and dry needling are among the early treatments utilised.

 

An X-Ray of a patient who presented to Prahran Foot Clinic with severe heel pain in 2014 (image used with permission). Note the large heel spur at the base of the heel.

 

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Retrocalcaneal Bursitis

A not infrequently seen condition often mistaken for Achilles pathology, retrocalcaneal bursitis is usually (and thankfully) quicker to resolve than its tendinous neighbour. Once again owing to excessive pronation/poor foot posture, a naturally occurring lubricating structure between the heel bone and the Achilles tendon (known as the retrocalcaneal bursa) becomes inflamed, causing pain just behind the Achilles and deeper towards the back of the ankle joint.

This diagnosis is usually made clinically (i.e. in the office on the day of your appointment), but can be confirmed using diagnostic ultrasound. Treatment by way of therapeutic ultrasound, strapping and custom orthotics are very effective in eliminating pain from retrocalcaneal bursitis.

Sever’s Disease

Most commonly seen in active boys aged 8-13, Sever’s Disease is a self-limiting condition (meaning it will always resolve in time) affecting one or both heels. During this period of growth, pain can be experienced if excessive forces travel through the growth plate of the heel. Unsurprisingly, children that participate in jumping sports are among the most common patients seen with this condition.

While the condition will resolve when the growth plate fuses with the heel bone (see image below), active treatment is still essential to ensure normal pain free participation in sports and activity. Stretches, strapping, therapeutic ultrasound, heel raises and custom orthotics are all conservative treatments that yield excellent results.

 

Sever's_Disease_X-ray
An X-Ray of a child’s foot shows the unfused growth plate of the heel bone (calcaneus).

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