Heel Pain

What causes it?

Heel pain is a relatively common problem and can be very distressing for patients. Plantar fasciitis (also known as heel spurs) is a very common cause of heel pain.  There are other less common causes which will need to be excluded such as stress fractures of the heel bone (calcaneum), irritation or pressure on the nerves supplying the area, problems with the Achilles tendon insertion, thinning of the protective padding of the heel and arthritis of the subtalar joint.

What is plantar fasciitis?

Plantar fasciitis causes pain in the heel which can radiate into the arch of the foot. It is often worse during the first few steps in the morning and also may get worse with prolonged standing and activity.

The plantar fascia is a strong band of tissue that lies under the foot between the heel and the toes. With age it can stiffen and become more susceptible to injury, often where it attaches to the heel. Unfortunately, the healing process is constantly set back by the need to walk on your foot which puts further stress through the damaged tissue.

How is it diagnosed?

A detailed history and careful examination is usually enough to diagnose plantar fasciitis however if there is suspicion of another cause of your heel pain then further investigations such as an MRI may be requested.

How is it treated?

Most people with plantar fasciitis will recover with conservative (non-surgical) treatment. The time course for recovery is slow, usually around 18 months.  Some people will still have some mild symptoms after this time but can usually cope with them using simple measures (warming up / stretching, mild analgesia).

A great number of treatments have been described for plantar fasciitis. Different treatments work well for different people and it is a matter of finding what works for you.  One of the most reliable forms of treatment is physiotherapy and stretching exercises  – our physiotherapists will guide you in this treatment. There are other ways of stretching such as night splint and Strassburg socks.

Insoles / orthotics, injections, icing and taping are other forms of treatment.  Shockwave therapy is a promising new treatment that can be arranged through the Hampshire Foot and Ankle Clinic. We have state of the art equipment available on site so that we can provide this treatment to suitable patients.

Will I need an operation?

Surgery is rarely required for this problem and should only be considered if all other treatments have failed and you are still incapacitated by pain after 12-18 months. The operation involves releasing the plantar fascia. It gives good results in 50% patients, 25% some improvement and 25% no difference or worse.