What is Heel Pain
Heel pain can be felt anywhere in the heel region from underneath the heel , the back of the heel where the Achilles tendon attaches, the inside or the outer borders of the heel.
Because of this there are many reasons as to why we may experience heel pain.
Some of the causes of heel pain are listed below:-
• Plantar fasciosis or tear
• Nerve entrapment ( medial calcaneal or lateral plantar) and sinus tarsi
• Muscle trigger points of muscles both within the foot and in the calf
• Referred pain from the pelvic region (S1)
• Fat pad bruising
Symptoms will vary depending on the mechanism of injury. Below are some brief outlines of common symptoms for the conditions mentioned above.
• Nerve problems tend to give a sharp or burning sensation and can be accompanied with small areas of pins and needles and numbness. This would be felt over the sole of the foot in this case.
• Muscle origin pain will often get worse with activity, and trigger points in soleus (deeper calf muscle) often increase in symptoms going uphill.
• Plantar fasciosis is often worse in the mornings on rising, and may actually improve with movement and activity. It will be normally be tender to touch on the inside part of the heel bone.
• Pain from the pelvic region will often get worse in sitting as the nerve root gets irritated and pain is felt along the path of the nerve. This type of pain can increase with flexion based activities.
• Fat pad contusion is normally due to a traumatic event and knock to the underside of the heel. It will be very painful on weightbearing although visible bruising is often not present.
Diagnosis will need to be made by a health professional to differentiate between the different causes of heel pain. As outlined above there are many different causes of heel pain that will all need a slightly different approach to treatment.
An MRI scan can be useful in supporting the diagnosis of plantar fascia pain, especially if there has been a tear in the tissue. The tear is often as a result of chronic stress of the fascia and may therefore require some immobilisation.
Treatment will vary depending on the condition. Apart from maybe S1 pain origin, treatment will almost always consist of postural correction of the lower limb and foot. Exercises and advise will be geared towards correct foot placement into neutral and strengthening the small muscles of the foot to support the arches. Passive support from orthotics can also be of great assistance and can be prescribed by your physio. It will important to address hip control and the association with foot placement.
Soft tissue releases can be of benefit if the nerves are restricted in their paths which is more common with sinus tarsi problems and with any pain that is a result of trigger points.
If pain is of an S1,2 origin treatment of the spine and pelvis will be required.
A bruised fat pad in the heel will normally require rest and footwear modification such as a gel heel pad for the shoe.
Recovery will vary on the condition which has been diagnosed. Sypmtms could easly diminish in the case of trigger point referral pain. On the other hand recovery may take a few months if surgery was required such as in the case of a tarsal tunnel release (sinus tarsi nerve related pain.
As with all lower limb and foot pain problems it is essential to have a thorough assessment of posture and dynamic control of the lower leg and and foot. It is possible here to pick up on weaknesses that can be corrected and may prevent any further problems arising. Correct biomechanics of the lower limb are essential in preventing future problems in the foot and with subsequent heel pain. Such an asseement should be able to be carried out by a physiotherapist.